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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 2026 to people living in Emerald Coast. 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 $106.00. 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 - Diabetes and Heart (HMO C-SNP) plan has an annual drug deductible of $615. For Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs, you will pay no copay when using standard pharmacies or preferred mail order. Standard mail order for Tier 1 and Tier 2 drugs requires a copay ranging from $10 to $60 depending on the supply. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. For higher-tier prescriptions, you will pay coinsurance instead of a copay, which includes 50% coinsurance for Tier 4 non-preferred drugs and 25% coinsurance for Tier 5 specialty drugs. These clear cost-sharing tiers help you understand your out-of-pocket pharmacy expenses.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive coverage with no copay for primary care visits, telehealth, and annual preventive screenings. Specialist visits require a copay between $20 and $40, while emergency room visits carry a $150 copay that is waived if you are admitted. For hospital stays, members pay a $250 daily copay for the first six days of inpatient care and no copay for days seven through ninety. This plan also includes valuable everyday benefits like routine dental, vision, and hearing exams with no copay, alongside a $1,500 annual allowance for dental services. Additionally, members can access up to 24 free one-way transportation trips per year to plan-approved locations with no copay. Essential medical equipment, diabetic supplies, and dialysis services are covered, generally requiring a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $250 daily copay for days 1 to 6 and no copay for days 7 to 90 for acute and psychiatric stays. Unlimited additional acute days are covered with no copay, but 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 services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $200, observation services require a $250 copay per stay, and outpatient substance abuse sessions cost a $20 to $35 copay, with prior authorization and referrals required.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), featuring a $0 to $260 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $150 copay and no coinsurance, with the copay 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 care, and emergency transportation are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers primary care physician services and telehealth visits with no copay and no coinsurance. Specialist exams, physical and occupational therapies, mental health services, and podiatry are covered with copays ranging from $20 to $40 and no coinsurance, though chiropractic benefits are only partially covered because routine chiropractic care is not covered.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), featuring no copay and no coinsurance for routine hearing exams, fitting evaluations, and OTC hearing aids. Medicare-covered exams require a $20 copay and no coinsurance, while prescription hearing aids are partially covered with a $199 to $1,299 copay and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over the ear types.
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, contact lenses, and eyeglasses with no copay, no coinsurance, and no deductible. Up to $200 of annual eyewear coverage is provided, but other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers partially covered dental services with a $1,500 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive services, a $20 copay and no coinsurance for Medicare-covered dental, and no copay with 30% coinsurance for removable prosthodontics. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, 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 no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and no coinsurance to 20% coinsurance, while covered Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. Durable medical equipment and diabetic supplies require a 20% coinsurance and no copay, prosthetic devices carry a 20% coinsurance, and medical supplies and diabetic shoes or inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, requiring prior authorization and referrals. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $200 copay for procedures, while radiological services range from no copay for X-rays to a minimum $25 copay and 20% coinsurance for therapeutic radiology.
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 and a referral are 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 coinsurance, but because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, the benefit is not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring no copay for days 1 to 20 and a $160 copay per day for days 21 to 100. This benefit is partially covered as additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partial coverage for other services with no copay and no coinsurance for covered benefits, though prior authorization is required for acupuncture and meal benefits. Covered services include acupuncture limited to 25 treatments yearly, over-the-counter items via reimbursement, and chronic illness meal benefits, while Dual Eligible SNPs with Highly Integrated Services and other additional 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
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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.
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