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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 Counties: LAK, MRN, ORA, OSC, SEM, SUM. 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 $152.00. 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 $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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and the pharmacy used. For example, in the initial coverage phase, preferred generic drugs have no copay at a standard pharmacy or preferred mail, but a $20 copay at a standard mail pharmacy. Once your total drug costs reach $2,000, 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 range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services range from no copay to $180. Emergency and urgent care services have copays, and primary care visits are covered with no copay. Preventive services, hearing exams, and vision services have copays, while dental services include a $20 copay for Medicare dental and a $1,500 annual maximum benefit for other dental services. The plan also provides coverage for home health services, medical equipment, and diagnostic services with copays or coinsurance. Additional benefits include acupuncture and an OTC allowance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $120 copay for days 1-4, and no copay for days 5-90, with no coinsurance; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has the same cost sharing as Inpatient Hospital-Acute.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay ranging from $0 to $180, observation services with a $120 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $20 and $100 for both individual and group sessions, and outpatient blood services with no copay. Prior authorization and a doctor referral are required for all services.
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 $45.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation services to a plan-approved health-related location. Ground ambulance services have a copay between $0 and $260, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location has no copay, and provides 24 one-way trips per year via taxi, bus/subway, or medical transport. Transportation services to any health-related location is not covered.
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 and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services have a $20 copay, and 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, Chiropractic Services with a $20 copay, and Occupational Therapy Services with a copay between $20 and $40. Physician Specialist Services have a $20 copay, and Mental Health Specialty Services, including individual and group sessions, have a $20 copay. Podiatry Services and Other Health Care Professional services have a copay that varies, but the maximum copay is $20. Psychiatric Services, including individual and group sessions, also have a $20 copay. Physical Therapy and Speech-Language Pathology Services have a copay between $20 and $40. Additional Telehealth Benefits have a copay between $0 and $20, and Opioid Treatment Program Services have a copay between $20 and $100.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services. This plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, and Routine Hearing Exams and Fitting/Evaluation for Hearing Aid are covered with no copay. Prescription Hearing Aids are covered, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear benefits. Eye exams have a copay between $0 and $20, and eyewear has no copay, with a combined maximum benefit of $300 every year.
Dental Services See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers dental services, including Medicare dental services with a $20 copay, and other dental services with a $1,500 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Prosthodontics, removable has a 30% coinsurance and no copay. Fluoride treatment, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan and require prior authorization and a doctor referral. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance, and Medical Supplies with no copay. Diabetic Equipment is covered with a 20% coinsurance for diabetic supplies and Medicare-covered therapeutic shoes or inserts, and no copay for diabetic supplies and therapeutic shoes/inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, procedures, tests, and lab services, are covered, with copays ranging from $0 to $150. Outpatient X-ray services have no copay, while diagnostic radiological services have a maximum copay of $175, and therapeutic radiological services have a maximum copay of $50 and a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered 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 not covered by the Humana Gold Plus Lung (HMO C-SNP) plan. Prior authorization and a doctor referral are required for coverage, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan, with a $0 copay for days 1-20 and a $195 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers acupuncture with no copay, up to 25 treatments per year, and also covers Over-the-Counter (OTC) items, including Nicotine Replacement Therapy (NRT) and Naloxone, up to $600 per year. The plan also offers a meal benefit with no copay for a chronic illness, but other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others 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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