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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 Counties: LAK, MRN, ORA, OSC, SEM, SUM. 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 $171.00. 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 $3100.00 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 features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generics and Tier 2 generics filled at standard pharmacies or via preferred mail order, as well as no copay for Tier 6 select care drugs across all filling options. Standard mail order copays for Tier 1 and Tier 2 drugs range from $10 to $60 depending on the drug tier and supply limit. Tier 3 preferred brand drugs require a $30 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. For advanced medications, the plan charges a 47% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. These straightforward cost-sharing options help you easily estimate your out-of-pocket prescription expenses under this Humana Medicare plan.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits and a low $15 copay for specialist appointments. For hospital stays, members pay a $120 daily copay for the first four days of inpatient care and no copay for days five through 90, with no coinsurance required. Emergency room visits carry a $150 copay, which is waived if you are admitted, while urgently needed services require a $15 copay. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing services with no copay, including up to a $300 annual allowance for eyewear and a $1,500 annual limit for dental care. Additionally, members can access up to 24 one-way transportation trips to plan-approved locations and receive acupuncture, over-the-counter items, and home health services with no copay or coinsurance. Most durable medical equipment, diabetic supplies, and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus Lung (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $120 copay per day for days 1 through 4 and no copay for days 5 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, while unlimited additional acute stay days are covered at no copay.
Outpatient Services See details
Humana Gold Plus Lung (HMO C-SNP) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $180 for outpatient hospital services and a $120 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay or coinsurance, while outpatient substance abuse sessions require a copay of $20 to $35.
Partial Hospitalization See details
Humana Gold Plus Lung (HMO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Lung (HMO C-SNP) covers ambulance services with a copay of $0 to $260 for ground transport and a 20% coinsurance for air transport, with prior authorization required. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
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 admitted to the hospital within 24 hours. Urgently needed services have a $15 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation 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, and specialist visits for a $15 copay and no coinsurance. Additional covered services like therapy, mental health, and telehealth carry copays ranging from $0 to $40 with no coinsurance, while some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus Lung (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness and in-home support with no copay and no coinsurance, while sub-services like health education, weight management, and medical nutrition therapy are not covered.
Hearing Services See details
Humana Gold Plus Lung (HMO C-SNP) offers hearing services with no deductible, featuring a $15 copay and no coinsurance for Medicare-covered exams, and no copay and no coinsurance for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with copays ranging from $199 to $1,299 and no coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus Lung (HMO C-SNP) provides partially covered vision services with no copay and no coinsurance, requiring prior authorization and referrals. Covered benefits include one routine eye exam per year and contact lenses or eyeglasses (lenses and frames) up to a $300 annual maximum, while other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Lung (HMO C-SNP) provides partially covered dental services up to a $1,500 annual limit, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive care. Removable prosthodontics are covered with no copay and a 30% coinsurance, while fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus Lung (HMO C-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus Lung (HMO C-SNP) plan with no copay and a 20% coinsurance. Members will need to obtain both a referral and prior authorization before receiving these services.
Medical Equipment See details
Humana Gold Plus Lung (HMO C-SNP) covers durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required for these services. Covered DME, prosthetic devices, and diabetic supplies require a 20% coinsurance and no copay, while medical supplies and diabetic therapeutic shoes or inserts are covered with no copay.
Diagnostic and Radiological Services See details
Humana Gold Plus Lung (HMO C-SNP) covers diagnostic and radiological services, with diagnostic procedures requiring no coinsurance and a copay between $0 and $150. Lab and diagnostic radiological services feature no copay and no coinsurance, while outpatient X-rays have no copay but require coinsurance. Therapeutic radiological services require a minimum $20 copay and a minimum 20% coinsurance, with prior authorization and referrals required for all 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, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus Lung (HMO C-SNP) with no coinsurance and no copay, though only some services are covered in practice as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation 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 but no prior three-day hospital stay. There is no copay for days 1 through 20, and a $160 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by the Humana Gold Plus Lung (HMO C-SNP) include acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits, all offered with no copay and no coinsurance. Acupuncture is limited to 25 treatments per year and, along with meal benefits, requires prior authorization, while OTC items are provided via reimbursement.
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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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