A non-government entity
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 Jacksonville Metro Area. 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 $109.00. 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:
Sign up for Humana Gold Plus Lung (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus Lung (HMO C-SNP) plan features an annual prescription drug deductible of $615. Beneficiaries can enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when utilizing standard pharmacies or preferred mail order. If you choose standard mail order, copays for generic tiers remain affordable, starting at $10 for a one-month supply. For brand-name and higher-tier medications, the plan transitions to copays and coinsurance. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply through standard pharmacies and preferred mail order. Meanwhile, Tier 4 non-preferred drugs require a 48% coinsurance, and Tier 5 specialty drugs carry a 25% coinsurance across all fulfillment methods.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care doctor visits, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $250 daily copay for the first seven days, while subsequent days require no copay. Specialist visits and outpatient hospital services are also highly accessible, featuring copays ranging from $0 to $200 with no coinsurance. This plan also includes valuable supplemental benefits, offering preventive dental care, routine hearing exams, and vision exams with no copay or coinsurance. Members can take advantage of a $1,500 annual dental limit, a $200 eyewear allowance, and up to 24 free one-way transportation trips to approved health locations. Other key perks include acupuncture, meals, and over-the-counter items with no copay, making this plan a robust option for overall wellness.
Inpatient Hospital See details
Humana Gold Plus Lung (HMO C-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $250 daily copay for days 1 to 7 and no copay for days 8 to 90. While unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus Lung (HMO C-SNP) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay, and outpatient hospital services with a copay of $0 to $200. Outpatient substance abuse sessions require a $20 to $35 copay with no coinsurance, and observation services incur a $250 copay per stay with no coinsurance.
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 covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus Lung (HMO C-SNP), featuring a $0 to $240 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Additionally, the plan covers up to 24 one-way trips per year to plan-approved health-related locations with no copay or 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, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Humana Gold Plus Lung (HMO C-SNP) are covered with no copay and no coinsurance for primary care provider visits. Specialist visits, mental health sessions, and physical therapies require copays ranging from $20 to $40 with no coinsurance, though routine chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus Lung (HMO C-SNP) covers preventive services like annual physicals, kidney disease education, and glaucoma screenings with no copay and no coinsurance. Additional preventive services are partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, 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, home safety devices, and counseling.
Hearing Services See details
Hearing Services are covered by Humana Gold Plus Lung (HMO C-SNP), featuring Medicare-covered exams for a $20 copay and no coinsurance, alongside routine exams, fittings, and unlimited OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $1,299, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Plus Lung (HMO C-SNP) partially covers vision services with no deductible and no coinsurance, offering eye exams with copays ranging from $0 to $20 and covered eyewear with no copay up to a $200 annual limit. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Lung (HMO C-SNP) offers partially covered dental services up to a $1,500 annual limit, featuring no copay and no coinsurance for preventive care like cleanings, exams, and x-rays. Medicare-covered dental requires a $20 copay and no coinsurance, while removable prosthodontics have no copay and a 30% coinsurance. Fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Lung (HMO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may be required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance with no copay, while covered Part B insulin requires a $35 copay and 0% 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. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Humana Gold Plus Lung (HMO C-SNP) covers medical equipment with prior authorization, offering durable medical equipment (DME) and prosthetic devices at a 20% coinsurance with no copay for DME. Medical supplies and diabetic therapeutic shoes are available with no copay, while diabetic supplies from specified manufacturers require a 10% coinsurance and no copay.
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 have no coinsurance, featuring no copay for lab services and a $0 to $200 copay for diagnostic procedures. Radiological services require a minimum 20% coinsurance and a minimum $25 copay for therapeutic services, while outpatient X-rays and diagnostic radiology have no copay, though coinsurance applies to X-rays.
Home Health Services See details
Humana Gold Plus Lung (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although 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 applicable copayments, requiring prior authorization and a referral. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus Lung (HMO C-SNP) with no coinsurance, requiring no copay for days 1 through 20 and a $160 copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus Lung (HMO C-SNP), offering acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Sub-services such as Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved