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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 Flagler and Volusia counties. 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 $116.00. 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) plan features an annual drug deductible of $615. Under this plan, you will enjoy no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when filled at standard pharmacies or through preferred mail order. Additionally, Tier 6 (Select Care Drugs) are covered with no copay across all standard pharmacy and mail order services. For Tier 3 (Preferred Brand) drugs, you will pay a $47 copay for a 1-month supply, though you can save on 3-month supplies using preferred mail order. Higher-tier medications require coinsurance, with Tier 4 (Non-Preferred) drugs requiring 50% coinsurance and Tier 5 (Specialty Tier) drugs requiring 25% coinsurance. Standard mail order delivery is also an option, with generic drug copays starting at $10.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) offers robust coverage for core medical services, featuring no copay for primary care visits and home health care. For inpatient hospital stays, there is a $175 daily copay for days 1 through 7 and no copay for days 8 through 90, while skilled nursing facilities require no copay for the first 20 days. Outpatient services, lab tests, and specialist visits generally feature low copays and no coinsurance, though emergency care carries a $150 copay that is waived if you are admitted. This plan also includes valuable supplemental benefits, such as preventive dental care, routine eye exams, and routine hearing services with no copays or coinsurance. Covered prescription hearing aids carry copays ranging from $199 to $1,299, while durable medical equipment and dialysis services require a 20% coinsurance. Additionally, members can access up to 24 one-way transportation trips per year and select over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus Lung (HMO C-SNP) inpatient hospital care is partially covered with no coinsurance, requiring a $175 copay per day for days 1 through 7 and no copay for days 8 through 90 for both acute and psychiatric stays. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus Lung (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services, a $175 copay per stay for observation services, and a $30 to $35 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, with prior authorization and referrals required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus Lung (HMO C-SNP) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus Lung (HMO C-SNP) covers ambulance and transportation services with prior authorization required. Ground ambulance services require a copay of $0 to $240 and coinsurance, while air ambulance services require 20% coinsurance and a copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though 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, which is 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 carry a $30 copay and therapy services range from a $20 to $40 copay with no coinsurance. Although some chiropractic services are covered, routine and other chiropractic services are not, and additional benefits like telehealth, mental health, and podiatry feature copays up to $35 with no coinsurance.
Preventive Services See details
Humana Gold Plus Lung (HMO C-SNP) preventive services are partially covered with no copays and no coinsurance for annual exams, diabetes training, and kidney education. However, several supplemental services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus Lung (HMO C-SNP) covers hearing services with no coinsurance, offering Medicare-covered exams for a $30 copay, alongside annual routine exams, fitting evaluations, and unlimited OTC hearing aids with no copay. Prescription hearing aids are partially covered with copays ranging from $199.00 to $1,299.00 and no coinsurance, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Humana Gold Plus Lung (HMO C-SNP) provides partially covered vision services with no deductible, no coinsurance, and copays ranging from no copay to $30. Routine eye exams and combined eyewear, including contact lenses and eyeglasses (lenses and frames), are covered with no copay up to a $200 annual limit, while other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Lung (HMO C-SNP) partially covers dental services up to a $2,000 annual limit, offering preventive care like cleanings and exams with no copay and no coinsurance. Medicare-covered dental services require a $30 copay, while restorative and periodontic services require a $25 copay (both with no coinsurance), but fluoride, endodontics, prosthodontics, implants, oral surgery, 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 and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while covered Part B insulin has a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Humana Gold Plus Lung (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Medical Equipment See details
Humana Gold Plus Lung (HMO C-SNP) covers durable medical equipment (DME) and diabetic supplies with a 20% coinsurance and no copay. Prosthetic devices are covered with a 20% coinsurance, while medical supplies and diabetic therapeutic shoes or inserts feature no copay and no coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus Lung (HMO C-SNP), requiring prior authorization and referrals. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $150 copay for procedures, while radiological services range from no copay for outpatient X-rays to a minimum $35 copay and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus Lung (HMO C-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus Lung (HMO C-SNP) provides cardiac rehabilitation services with no coinsurance, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. A referral and prior authorization are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus Lung (HMO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $160 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus Lung (HMO C-SNP), which offers acupuncture, over-the-counter (OTC) items, and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture (limited to 25 treatments per year) and meal benefits, while other miscellaneous benefits 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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