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Gold Dialysis (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Dialysis (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 Dialysis (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold Dialysis (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 Dialysis (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 Dialysis (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 Dialysis (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 Dialysis (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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3100.00 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 Dialysis (HMO-POS C-SNP) plan has an enhanced alternative drug benefit. This plan has a $0 deductible. In the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy. For example, standard generic drugs have a $47 copay, while preferred generic drugs have a $5 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Gold Dialysis (HMO-POS C-SNP) plan offers a wide range of benefits, including inpatient and outpatient hospital services, with varying copays. This plan also covers a variety of services such as primary care, preventive care, hearing, vision, and dental services. Notably, there is no copay for many services including dental, dialysis, and home health services. This plan provides coverage for emergency services, ambulance services, and skilled nursing facility stays. Additionally, the plan includes coverage for medical equipment, diagnostic and radiological services, and home infusion services. However, some services like cardiac rehabilitation and additional hours of home health care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-7, the copay is $150 per admission, and there is no copay for days 8-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, and Non-Medicare-covered stays for both, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, and outpatient substance abuse services. Outpatient Hospital Services have a copay of $0-$150, and Observation Services have a copay of $150. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have a 20% coinsurance. Individual sessions for outpatient substance abuse have a copay of $25, and group sessions have a copay of $15.
Partial Hospitalization See details
Partial Hospitalization is covered under the Gold Dialysis (HMO-POS C-SNP) plan with a copay of $80 and requires prior authorization. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan, including all ambulance services and transportation services to any health-related location. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation Services - Plan Approved Health-related Location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $120 copay, while Urgently Needed Services have a $40 copay.
Primary Care See details
The Gold Dialysis (HMO-POS C-SNP) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a $0-$15 copay, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a $10 copay, and opioid treatment program services with a $25 copay. Routine chiropractic care is limited to 12 visits per year.
Preventive Services See details
Preventive Services covered by the Gold Dialysis (HMO-POS C-SNP) plan include Medicare-covered preventive services, an annual physical exam, health education, in-home safety assessments, Personal Emergency Response Systems (PERS), 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; however, Medical Nutrition Therapy (MNT), wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams, routine hearing exams, and fitting/evaluation for hearing aids. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is no deductible for any of the vision services. Routine eye exams are unlimited. Eyewear has a maximum plan benefit coverage of $625 every three months.
Dental Services See details
The Gold Dialysis (HMO-POS C-SNP) plan covers dental services, with a maximum plan benefit of $625 every three months. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are all covered with no copay or coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. 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 by the Gold Dialysis (HMO-POS C-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered items, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
The Gold Dialysis (HMO-POS C-SNP) plan covers diagnostic and radiological services, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $75, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Gold Dialysis (HMO-POS C-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $20 copay, over-the-counter items, and a meal benefit for chronic illness. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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