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Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - Diabetes and Heart (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 - Diabetes and Heart (HMO C-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in OR. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus - Diabetes and Heart (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 - Diabetes and Heart (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 - Diabetes and Heart (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 - Diabetes and Heart (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 $1.00. 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 $9250.00 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 - Diabetes and Heart (HMO C-SNP) plan features an annual drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at a standard pharmacy or through preferred mail order. If you choose standard mail order for these lower-tier medications, you will pay copays ranging from no copay up to $60 depending on the tier and supply length. For Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance regardless of whether you use a standard pharmacy, preferred mail order, or standard mail order. This 25% coinsurance applies to both 1-month and 3-month supplies, though Tier 5 specialty medications are limited to a 1-month supply.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care, specialist visits, and outpatient services, which generally require a 20% coinsurance. Inpatient hospital stays require set copays of $2,230 for acute care or $2,080 for psychiatric care per stay, with no coinsurance. Additionally, essential services like home health care and routine preventive care are fully covered with no copay and no coinsurance. For supplemental care, members benefit from dental and vision coverage, including up to $500 annually for eyewear and non-Medicare dental services with no copay and no coinsurance. Routine hearing exams, fitting evaluations, and over-the-counter hearing aids are also available with no copay, while prescription hearing aids require a copay between $199 and $499. The plan also includes convenient extras such as acupuncture, over-the-counter items, and up to 26 one-way transportation trips per year to approved locations at no cost.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and while unlimited additional acute care days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services with no copay and 20% coinsurance. Outpatient blood services are also covered with no copay and no coinsurance, with prior authorization required for most services.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ambulance services with no coinsurance and a copay of $335 for ground and $1,250 for air transport. Transportation services are partially covered with no copay or coinsurance for up to 26 one-way trips per year to plan-approved locations, while trips to any other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers primary care, specialist, therapy, podiatry, and mental health services with no copay and 20% coinsurance, while chiropractic services are not covered in practice. Telehealth services are also covered with a copay ranging from $0 to $40 and 20% coinsurance.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) features partially covered preventive services, offering annual physicals, kidney disease education, diabetes self-management training, and memory fitness benefits with no copay and no coinsurance, while alternative therapies require a $20 copay and no coinsurance. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) include routine annual exams with no copay and 20% coinsurance, alongside fitting evaluations and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with a $199 to $499 copay and no coinsurance for up to two devices per year, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), offering one routine eye exam per year with no copay, a 20% coinsurance, and no deductible. Up to $500 of annual eyewear is covered with no copay, no coinsurance, and no deductible for contacts or eyeglasses (lenses and frames), but other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance, and other dental services up to a $500 annual limit with no copay and no coinsurance. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Home Infusion bundled services with prior authorization, featuring a $35 copay and 0% to 20% coinsurance for Part B insulin. Other covered Part B drugs require no copay and 0% to 20% coinsurance, while chemotherapy and radiation drugs have 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a 20% coinsurance and require prior authorization. Outpatient diagnostic procedures and tests have a copay up to $40, outpatient X-rays carry a $40 copay, and lab services and diagnostic radiological services have no copay.
Home Health Services See details
Home health services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and require prior authorization, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered under this benefit and require coinsurance between 8% and 20%.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20 and days 66 through 100, a $218 daily copay for days 21 through 65, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers acupuncture up to 25 treatments per year, over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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