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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 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 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 $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 Lung (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries can access Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs with no copay when using standard pharmacies or preferred mail order. If you choose standard mail order for these lower-tier drugs, you will pay a copay starting at $10 for a one-month supply of Tier 1 drugs and $20 for Tier 2 drugs. For Tier 3 preferred brand drugs, the plan charges a $45 copay for a one-month supply at standard pharmacies and preferred mail order, or $47 through standard mail order. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance across all standard and mail order options.
Additional Benefits
The Humana Gold Plus Lung (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits and a $20 copay for specialist visits. For hospital care, inpatient stays require a $250 daily copay for days one through seven and no copay for subsequent days, while outpatient hospital services feature copays ranging from $0 to $200. Emergency room visits carry a $150 copay, which is waived upon admission, and urgent care services require a $15 copay. In addition to core medical care, this plan provides robust supplemental coverage including preventive dental services up to a $1,500 annual limit and routine vision exams with no copay. Members also receive no copay for routine hearing exams, up to $200 annually for eyewear, and up to 24 one-way transportation trips to approved locations. Home health care and many preventive services are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus Lung (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $250 daily copay for days 1 through 7 and no copay for days 8 and beyond. Unlimited additional acute care days are covered, but the plan does not cover additional psychiatric days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Humana Gold Plus Lung (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $200 ($250 per stay for observation services), while outpatient substance abuse sessions have a copay of $20 to $35.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus Lung (HMO C-SNP) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus Lung (HMO C-SNP), with ground ambulance services requiring a $0 to $240 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 yearly one-way trips to plan-approved locations, while 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 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, and specialist visits for a $20 copay and no coinsurance. Physical, occupational, and speech therapy services require a $25 to $40 copay and no coinsurance, while chiropractic services are only partially covered because routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus Lung (HMO C-SNP) with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, and select supplemental services like in-home support and fitness. Several supplemental services are not covered, such as health education, medical nutrition therapy, weight management programs, and home safety assessments.
Hearing Services See details
Humana Gold Plus Lung (HMO C-SNP) covers Medicare-covered hearing exams with a $20 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids are available with no copay or coinsurance. Prescription hearing aids are partially covered with a $199 to $1,299 copay and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus Lung (HMO C-SNP) vision services are partially covered, featuring no deductible, no coinsurance, and a $0 to $20 copay for eye exams, alongside no copay for covered eyewear up to a $200 yearly limit. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, other eye exam services, eyeglass lenses, 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 $1,500 annual limit with no copay and no coinsurance for most preventive and comprehensive options, though Medicare-covered dental has a $20 copay (no coinsurance) and removable prosthodontics require a 30% coinsurance (no copay). Fluoride treatments, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, 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 is required. Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while covered insulin requires a $35 copay and no coinsurance to 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 prosthetic devices with a 20% coinsurance and no copay, while medical supplies and diabetic therapeutic shoes or inserts have no copay and no coinsurance. Diabetic supplies are covered with a 10% coinsurance and no copay, subject to manufacturer limitations and prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus Lung (HMO C-SNP), featuring no copay or coinsurance for lab services and diagnostic tests ranging from a $0 to $200 copay with no coinsurance. Diagnostic radiological services start at no copay, outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services carry at least a $25 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus Lung (HMO C-SNP) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered under the Humana Gold Plus Lung (HMO C-SNP) with no coinsurance, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copayments of $10, $10, $20, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Lung (HMO C-SNP) covers skilled nursing facility care 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
Humana Gold Plus Lung (HMO C-SNP) provides partial coverage for other services with no copay and no coinsurance, including acupuncture (up to 25 treatments per year), over-the-counter items, and chronic illness meals. Prior authorization is required for acupuncture and meal benefits, while Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated 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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