Gold Heart & Diabetes Complete (HMO-POS C-SNP)

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 2026.

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.

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.

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:

Drug Coverage

The Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan features an annual prescription drug deductible of $615. Members can minimize their out-of-pocket expenses by utilizing preferred pharmacies and preferred mail-order services, which offer no copays or cost-sharing across all drug tiers. Standard pharmacies and standard mail-order options, on the other hand, require coinsurance payments. Under standard pharmacy and standard mail-order coverage, Tier 1 preferred generics, Tier 2 generics, and Tier 3 preferred brands require a 24% coinsurance, while Tier 4 non-preferred brands carry a 26% coinsurance. Tier 5 specialty drugs incur a 25% coinsurance for a one-month supply at standard pharmacies, and Tier 6 select diabetic drugs feature a 15% coinsurance. This plan provides highly competitive rates for prescription medications, especially when utilizing preferred network pharmacies.

Additional Benefits

The Gold Heart and Diabetes Complete (HMO-POS C-SNP) plan offers comprehensive coverage for essential medical services, typically requiring no copayments but featuring a 20 percent coinsurance for most outpatient, specialist, emergency, and diagnostic services. Inpatient hospital stays and skilled nursing facility care are covered with no copays or coinsurance, though inpatient services do require a deductible and prior authorization. Preventive care, home health services, and routine prescription hearing aids are also fully covered with no copay or coinsurance. For supplemental care, the plan features dental benefits up to a 4,000 dollar annual limit and vision coverage with no copays, including up to 300 dollars for eyeglasses with no coinsurance. Additionally, members can access up to 22 one-way plan-approved transportation trips per year with no copay and no coinsurance. However, certain benefits like cardiac rehabilitation and over-the-counter items are not covered under this plan.