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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 2025, 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 out of 5 stars in 2025.
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 $92.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has an enhanced alternative drug benefit. This plan has no deductible. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay a $0 copay for preferred generic drugs at a standard pharmacy, and 50% coinsurance for preferred brand drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) plan offers a variety of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. Emergency, urgent, and worldwide emergency services have copays, while primary care and many preventive services have no copay. The plan also covers hearing, vision, and dental services, with specific copays, annual maximums, and limitations on coverage for certain services. Additional benefits include ambulance and transportation services, with copays or coinsurance, and home health services with no copay. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility stays, each with specific cost-sharing. Other covered services include acupuncture, over-the-counter items, and a meal benefit, all subject to certain conditions and limitations.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 6 days of an Inpatient Hospital stay, there is a $125 copay, and days 7-90 have no copay; for additional days, there is no copay. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute, and additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan. Outpatient Hospital Services have a copay of $0-$150, Observation Services have a $125 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $15 and $85, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus Lung (HMO C-SNP) plan, but requires prior authorization. The copay for this benefit is $35.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan, with prior authorization required. Ground ambulance services have a copay of $0 - $215, while air ambulance services have a 20% coinsurance. Transportation services have no copay, and transportation to a plan-approved health-related location is covered for up to 50 one-way trips per year via taxi, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan. Emergency Services have a $90 copay, Urgently Needed Services have a $15 copay, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a copay between $15 and $20, while physician specialist services have a $15 copay. Mental health, podiatry, other health care professional, psychiatric, and opioid treatment services have copays starting at $15, and physical therapy and speech-language pathology services have a copay between $15 and $20. Additional telehealth services have a copay between $0 and $15.
Preventive Services See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing exams are covered with a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, but limited to one visit per year. Prescription hearing aids are covered, but only prescription hearing aids of all types are covered with a copay between $199 and $1299, limited to two visits per year, while inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay between $0 and $15, and eyewear with no copay, with a combined maximum plan benefit of $300 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum. Medicare Dental Services have a $15 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services have no coinsurance. Fluoride Treatment, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered. Restorative Services have a $25 copay, and Adjunctive General Services have no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, and other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with no coinsurance, and Diabetic Equipment, with some services requiring coinsurance or copays. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, and Therapeutic Radiological Services have a copay of at most $15 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus Lung (HMO C-SNP) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. Over-the-counter (OTC) items are covered, including nicotine replacement therapy and naloxone, up to $360 per year. A meal benefit is also included with no copay, but requires prior authorization. However, services for Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services such as private duty nursing and case management are not covered.
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