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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 Jacksonville Metro and Emerald 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 $98.00. 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 no deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and the pharmacy you use. For example, you will pay no copay for preferred generic drugs at a standard pharmacy or preferred mail. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your 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 Lung (HMO C-SNP) plan offers a wide range of benefits, including inpatient hospital stays with a copay for the first 7 days and no copay thereafter, along with coverage for outpatient services, partial hospitalization, ambulance and transportation services, and emergency services. The plan also covers primary care visits, preventive services, hearing exams and hearing aids, vision services, dental services, home infusion, dialysis, medical equipment, and diagnostic services. Additional benefits include home health services, skilled nursing facility stays with varying copays, and coverage for acupuncture, over-the-counter items, nicotine replacement therapy, Naloxone, and a meal benefit. However, it's important to note that some services require prior authorization, and there may be copays, coinsurance, and annual limits associated with certain benefits. Cardiac Rehabilitation Services are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 7 days, there is a $250 copay, and days 8-90 have no copay. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $200, Observation Services with a $250 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $25 and $75 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, and requires prior authorization. The copay for this benefit is $45.
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 $260, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a $140 copay and no coinsurance. Urgently Needed Services are covered, with a $25 copay and no coinsurance. Worldwide Emergency Services are covered, with a $140 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay. Chiropractic services require a $20 copay. Occupational Therapy Services have a copay between $25 and $40. Physician Specialist Services, Mental Health Specialty Services, and Psychiatric Services have a $20 copay for individual sessions and a $25 copay for group sessions. Podiatry Services and Other Health Care Professional have a copay between $20 and $25. Physical Therapy and Speech-Language Pathology Services have a copay between $25 and $40. Additional Telehealth Benefits have a copay between $0 and $25. Opioid Treatment Program Services have a copay between $25 and $75.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered, though some services may have a copay.
Hearing Services See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers hearing exams with a $20 copay and routine hearing exams with no copay. Prescription hearing aids are covered with a copay between $199 and $1299, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $20, while routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), have no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus Lung (HMO C-SNP) plan covers Medicare Dental Services with a $20 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Periodontics, Prosthodontics (removable) with a 30% coinsurance, and Oral and Maxillofacial Surgery with no copay, but does not cover Fluoride Treatment, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), or Orthodontics. This plan also offers a maximum of $1500 per year for Other Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus Lung (HMO C-SNP) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and Prosthetic Devices have a 20% coinsurance. Diabetic Supplies have a 10% coinsurance, while Diabetic Therapeutic Shoes/Inserts and Medical Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a copay between $0 and $200, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, and Therapeutic Radiological Services have a copay up to $50 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. 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. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus Lung (HMO C-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $175.
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 items are covered with a maximum benefit of $780 per year, and the plan offers nicotine replacement therapy and Naloxone. The plan also covers a meal benefit with no copay, for a chronic illness, but many other services 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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