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Gold Heart & Diabetes Complete (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Heart & Diabetes Complete (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 Complete (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold Heart & Diabetes Complete (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 2025.
It's important to know that Gold Heart & Diabetes Complete (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 Complete (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 Complete (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 Complete (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $590.00 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 $9350.00 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 Complete (HMO-POS C-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the cost-sharing amounts for your prescriptions. The plan's formulary provides more specific details on which drugs are covered. If you qualify for the low-income subsidy, you will pay $20.30 for your Part D premium. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with coinsurance ranging from 0% to 20% depending on the service. The plan also covers emergency services and offers additional benefits such as hearing, vision, and dental services, with specified coinsurance and maximum benefit amounts for some services, such as a maximum hearing benefit of $950 every three months. Additional benefits include home health services with no copay or coinsurance, and coverage for medical equipment, dialysis, and home infusion services. This plan also covers ambulance and transportation services, diagnostic and radiological services, and other services such as acupuncture and over-the-counter items. However, it's important to note that services like cardiac rehabilitation, certain hearing aids, and specific types of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, though the exact cost sharing details for coinsurance and deductibles are not specified. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and outpatient blood services have a 20% coinsurance, while outpatient substance abuse services have a 20% coinsurance for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan. All Ambulance Services are covered with a 20% coinsurance for both ground and air ambulance services, and Transportation Services are partially covered, with 23 one-way trips per year to any health-related location covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Urgently Needed Services, you pay 20% coinsurance, and there is no copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under this plan. With this plan, you will pay 20% coinsurance for Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits. For Routine Chiropractic Care you are limited to 12 visits every year with 20% coinsurance. For Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services the coinsurance is between 20% and 20%.
Preventive Services See details
The Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, health education, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, therapeutic massage, fitness benefits, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Medical Nutrition Therapy, wigs for hair loss, weight management programs, alternative therapies, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers, additional sessions of smoking cessation counseling, enhanced disease management, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with coinsurance of at most 20% and a maximum plan benefit of $950 every three months, and Prescription Hearing Aids (all types), but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear with a 20% coinsurance, and contact lenses, eyeglass lenses, eyeglass frames, and upgrades are also covered. Routine eye exams are covered with a maximum benefit of $950 every three months.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services have a maximum benefit of $950 every three months, and additional services like Oral Exams, Dental X-Rays, and Orthodontics are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, with a 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan with no copay. For diagnostic procedures, tests, and lab services, you may have to pay up to 20% coinsurance, and for diagnostic, therapeutic, and outpatient X-ray services, you may also have to pay up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required and you will pay the Medicare-defined cost share for tier 1.
Other Services See details
The Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan covers acupuncture with 20% coinsurance, up to 12 treatments per year. Over-the-counter items and meal benefits for chronic illnesses are also covered. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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