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Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - Diabetes and Heart (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 - Diabetes and Heart (HMO C-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus - Diabetes and Heart (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 - Diabetes and Heart (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 - Diabetes and Heart (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 - Diabetes and Heart (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 - Diabetes and Heart (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 - Diabetes and Heart (HMO C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays and coinsurance amounts depending on the drug tier and pharmacy type. For example, you will pay no copay for preferred generic drugs at a standard pharmacy or through preferred mail order, but you will pay a $20 copay for standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a variety of benefits with a focus on managing diabetes and heart conditions. This plan includes coverage for inpatient and outpatient hospital services with varying copays, as well as coverage for emergency services and ambulance transportation. You'll find that many primary care and specialist services have low copays, and the plan also provides preventive services like annual physical exams with no copay. Additional benefits include coverage for hearing and vision services, with copays for exams and coverage for hearing aids and eyewear. Dental services are also included with a $15 copay for Medicare-covered services and up to $1,500 for other services. Home health services, medical equipment, and diagnostic services are covered with copays or coinsurance, and the plan offers extra perks like coverage for over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $125 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are covered with a $125 copay for days 1-6 and no copay for days 7-90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $150, observation services have a $125 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse individual and group sessions 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 - Diabetes and Heart (HMO C-SNP) plan. You will have a $35 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a copay between $0 and $215, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with a limit of 50 one-way trips per year, and no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Emergency Services have a $140 copay with no coinsurance, Urgently Needed Services have a $15 copay with no coinsurance, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay with no coinsurance.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic services have a $15 copay. Occupational Therapy Services have a copay between $15-$20. Physician Specialist Services and Mental Health Specialty Services have a $15 copay. Podiatry Services have a $15 copay. Other Health Care Professional services have a copay between $0-$15. Psychiatric Services have a copay of $15 for both individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a copay between $15-$20. Additional Telehealth Benefits have a copay between $0-$15. Opioid Treatment Program Services have a copay between $15-$85.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services, with copays for Fitness Benefit and In-Home Support Services. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing services include hearing exams with a $15 copay and routine hearing exams with no copay. Prescription hearing aids are covered, with a copay between $199 and $1299 depending on the type.
Vision Services See details
Vision services include eye exams, routine eye exams, and eyewear benefits. Eye exams have a copay of $0 to $15, while routine eye exams and eyewear have no copay, with a combined maximum plan benefit coverage of $300 per year for eyewear. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers dental services, including Medicare Dental Services with a $15 copay, and other services up to a $1,500 maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no coinsurance. Restorative services are covered with a $25 copay, and adjunctive general services are covered with no coinsurance. Fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is a $35 copay for Medicare Part B Insulin Drugs, and a coinsurance between 0% and 20% for all covered services.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), including Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with no coinsurance and a copay for Medicare-covered items. Diabetic Equipment is also covered, with a 20% coinsurance and no copay for Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $95, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $150, Therapeutic Radiological Services have a copay up to $15 and a 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $150 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers acupuncture with no copay, up to 25 treatments per year, and requires prior authorization. Over-the-counter items are covered up to $360 per year, including nicotine replacement therapy and naloxone. Meal benefits are covered with no copay and require prior authorization. Other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more 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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