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Humana Gold Plus Lung (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Lung (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus Lung (HMO C-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus Lung (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Gulf Coast. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus Lung (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus Lung (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus Lung (HMO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Gold Plus Lung (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $104.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3300.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Gold Plus Lung (HMO C-SNP) prescription drug plan has an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when filled at standard pharmacies or through preferred mail order. Standard mail order options for these lower tiers incur a copay, such as $10 for Tier 1 and $20 for Tier 2 for a one-month supply. For Tier 3 preferred brand drugs, you will pay a low $5 copay for a one-month supply at standard pharmacies and preferred mail order, or a $47 copay via standard mail order. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance regardless of whether you use standard pharmacies, preferred mail order, or standard mail order.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) plan offers comprehensive medical coverage with low out-of-pocket costs, including no copay or coinsurance for primary care visits and routine preventive services. For hospital stays, members pay a daily copay of $125 for the first six days of inpatient care and no copay for days 7 through 90. Outpatient services feature no coinsurance, with copays ranging from no copay for ambulatory surgical centers up to $150 for outpatient hospital services. This plan also includes valuable extra benefits such as routine dental, vision, and hearing services with no copay or coinsurance, subject to specific annual limits. Additionally, members can access up to 50 one-way transportation trips per year, select over-the-counter items, and chronic illness meals at no cost. Specialist visits, urgent care, and Medicare-covered dental or hearing exams are also highly affordable, requiring only a small $15 copay.
Inpatient Hospital See details
Humana Gold Plus Lung (HMO C-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, though prior authorization is required. For both stay types, you will pay a $125 daily copay for days 1 through 6 and no copay for days 7 through 90, with unlimited additional acute days covered at no copay. This benefit is partially covered, as additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus Lung (HMO C-SNP) with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $150 copay, observation services carry a $125 copay per stay, and outpatient substance abuse sessions have a $20 to $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Plus Lung (HMO C-SNP) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus Lung (HMO C-SNP) covers ambulance services and partially covers transportation services, as trips to any health-related location are not covered. Ground ambulance services require a $0 to $240 copay with no coinsurance, air ambulance services require a 20% coinsurance with no copay, and plan-approved transportation includes up to 50 one-way trips per year with no copay or coinsurance.
Emergency Services See details
Humana Gold Plus Lung (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Lung (HMO C-SNP) provides primary care physician services with no copay and no coinsurance, while specialist visits and podiatry require a $15 copay and no coinsurance. Therapy, mental health, and telehealth services feature copays ranging from $0 to $20 with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus Lung (HMO C-SNP) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness and in-home support services with no copay or coinsurance, while services like health education, nutritional therapy, and home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus Lung (HMO C-SNP) covers hearing services with no deductible and no coinsurance, offering routine exams, fitting evaluations, and OTC hearing aids with no copay, alongside Medicare-covered exams for a $15 copay. Prescription hearing aids are partially covered with copays ranging from $199 to $1,299, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services covered by Humana Gold Plus Lung (HMO C-SNP) include one annual routine eye exam with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $300 yearly limit for contact lenses and combined eyeglasses (lenses and frames), but individual lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Humana Gold Plus Lung (HMO C-SNP) plan, offering preventive services like cleanings and exams with no copay and no coinsurance up to a $1,500 annual limit. Restorative services have a $25 copay and no coinsurance, and Medicare-covered dental has a $15 copay and no coinsurance, but fluoride, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Lung (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, such as chemotherapy and radiation, carry a coinsurance ranging from no coinsurance to 20%, while insulin is available for a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus Lung (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Medical Equipment See details
Humana Gold Plus Lung (HMO C-SNP) covers durable medical equipment and diabetic supplies with a 20% coinsurance and no copay. Prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered with no copay and no coinsurance, though prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus Lung (HMO C-SNP), with prior authorization and referrals required. Diagnostic services have no coinsurance, offering no copay for lab services and a $0 to $95 copay for diagnostic procedures. Radiological services feature no copay for outpatient X-rays, no copay for some diagnostic and therapeutic services, and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus Lung (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus Lung (HMO C-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Lung (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20 and a $160 copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus Lung (HMO C-SNP) partially covers other services, providing acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for meal benefits and acupuncture, which is limited to 25 treatments annually, while dual-eligible SNP services are not covered.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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