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Gold Heart & Diabetes (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Heart & Diabetes (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Gold Heart & Diabetes (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Gold Heart & Diabetes (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by Gold Kidney Health Plan available for enrollment in 2025 to people living in Jacksonville, West Fl, Treasure Coast, & South Fl. The overall rating for this plan is not yet available for 2026.
It's important to know that Gold Heart & Diabetes (HMO-POS C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Gold Heart & Diabetes (HMO-POS 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 Gold Heart & Diabetes (HMO-POS 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 Gold Heart & Diabetes (HMO-POS 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 $120.00. 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 $2700.00 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 Gold Heart & Diabetes (HMO-POS C-SNP) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs, Tier 2 generic drugs, and Tier 6 select diabetic drugs filled through standard pharmacies or standard mail order. This makes managing everyday health needs and diabetic care highly affordable. For brand-name and specialty medications, copays and coinsurance vary by drug tier. Tier 3 preferred brands carry a standard pharmacy copay starting at $40, while Tier 4 non-preferred brands start at a $100 copay for a one-month supply. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Gold Heart & Diabetes (HMO-POS C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth services, preventive care, and home health care. For inpatient hospital stays, members pay a $220 daily copay for days 1 through 5 and no copay for days 6 through 90, with no coinsurance. Emergency room visits carry a $120 copay, which is waived if admitted, while specialist and routine chiropractic visits require low copays between $10 and $25. Additional benefits include preventive dental care with no copay up to a $4,000 annual limit, as well as routine vision and hearing exams for a $20 copay. The plan also covers up to 24 one-way transportation trips to approved locations and diabetic equipment with no copay. While some services like durable medical equipment and dialysis require a 20% coinsurance, the plan provides strong financial protection for essential health needs.
Inpatient Hospital See details
Gold Heart & Diabetes (HMO-POS C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $220 daily copay for days 1 through 5 and no copay for days 6 through 90. While acute and psychiatric stays are covered, this benefit is considered partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) outpatient services are covered with no coinsurance and copays ranging from $0 to $220 for outpatient hospital and observation services, while ambulatory surgical center services have no copay and no coinsurance. Outpatient substance abuse services require no coinsurance with a $15 copay for group sessions and a $25 copay for individual sessions, and outpatient blood services are covered with no copay and 20% coinsurance.
Partial Hospitalization See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers partial hospitalization services with an $80.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers ground ambulance services with a $225 copay and air ambulance services with a 20% coinsurance. Up to 24 one-way transportation trips per year to plan-approved locations are covered with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers emergency services with a $120 copay, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $10 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $120 copay and no coinsurance, up to a maximum plan benefit of $75,000.
Primary Care See details
Primary care services are covered by Gold Heart & Diabetes (HMO-POS C-SNP) with no coinsurance, featuring no copay for primary care physicians and telehealth, and copays between $10 and $25 for specialist, therapy, and mental health visits. Chiropractic care is partially covered, offering routine visits for a $20 copay with no coinsurance while excluding other chiropractic services.
Preventive Services See details
Preventive services are covered under the Gold Heart & Diabetes (HMO-POS C-SNP) plan with no copay and no coinsurance, including annual physical exams and kidney disease education. Additional preventive benefits are only partially covered, as services like health education, medical nutrition therapy, weight management, and alternative therapies are not covered.
Hearing Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) provides partially covered hearing services, featuring annual routine exams for a $20 copay and no coinsurance. Up to two prescription hearing aids are covered each year with a copay between $195 and $1,395 and no coinsurance, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) offers partially covered vision services, featuring one annual routine eye exam for a $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to annual limits of $200 for eyeglasses, lenses, or frames, and $115 for contact lenses, though upgrades are not covered.
Dental Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) offers partially covered dental services with an annual maximum benefit of $4,000, featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care. Restorative, endodontic, and periodontic services are covered with no copay and a 20% coinsurance, while other diagnostic dental, prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Gold Heart & Diabetes (HMO-POS C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers medical equipment with no copays, though a 20% coinsurance applies to durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Gold Heart & Diabetes (HMO-POS C-SNP), as outpatient X-ray services are not covered. Covered diagnostic services require no coinsurance, with no copay for lab services and a $0 to $30 copay for diagnostic procedures. Prior-authorized radiological services feature diagnostic radiological services with no copay or coinsurance, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Gold Heart & Diabetes (HMO-POS C-SNP) with no copay and no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $214 copay for days 21 through 100, and additional days beyond Medicare-covered services are not covered.
Other Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) provides partial coverage for other services, including acupuncture for a $20 copay and no coinsurance up to 12 treatments per year, and meal benefits for chronic illnesses with no copay and no coinsurance with a referral. Over-the-counter (OTC) items are not covered under this plan.
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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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