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Gold Dialysis & Kidney (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Dialysis & Kidney (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 & Kidney (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Gold Dialysis & Kidney (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 Dialysis & Kidney (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 & Kidney (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 & Kidney (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 & Kidney (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 & Kidney (HMO-POS C-SNP) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. You will pay no copay for Tier 1 preferred generic drugs and Tier 6 select diabetic drugs through standard pharmacies and mail order services. For Tier 2 generic medications, standard pharmacy copays range from $5 to $12, while standard mail order offers a flat $5 copay for up to a three-month supply. Brand name and specialty drugs require higher cost-sharing, with Tier 3 preferred brands starting at a $40 copay via mail order or a $47 copay at standard pharmacies for a one-month supply. Tier 4 non-preferred brands carry a $100 copay for a one-month supply, while Tier 5 specialty drugs require a 33% coinsurance. Choosing standard mail order for Tier 3 drugs can provide additional savings on multi-month supplies compared to standard retail pharmacies.
Additional Benefits
The Gold Dialysis & Kidney (HMO-POS C-SNP) plan offers robust medical coverage designed to minimize out-of-pocket costs for critical healthcare needs. Beneficiaries enjoy essential services with no copay and no coinsurance, including dialysis services, primary care visits, home health care, and covered preventive screenings. For inpatient hospital stays, there is no coinsurance and no copay after the seventh day, though a daily copay of $150 applies for the first seven days. This plan also features valuable everyday benefits to support your overall well-being, including dental coverage up to a $5,000 annual limit with no copay for most preventive and comprehensive care. Routine vision and hearing exams are available with a low $15 copay, while covered eyewear has no copay and prescription hearing aids feature no coinsurance. Additionally, the plan covers up to 24 one-way trips per year to approved health locations with no copay, ensuring reliable transportation to your medical appointments.
Inpatient Hospital See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For both acute and psychiatric stays, you will pay a copay of $150 per day for days 1 through 7, and no copay for days 8 through 90, while additional hospital days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers outpatient hospital and observation services with no coinsurance and copays ranging from $0 to $150, while ambulatory surgical center services have no copay and no coinsurance. Outpatient substance abuse services require no coinsurance with copays of $15 for group and $25 for individual sessions, and outpatient blood services feature no copay and a 20% coinsurance.
Partial Hospitalization See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers partial hospitalization services with an $80 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers ground ambulance services with a $200 copay and air ambulance services with a 20% coinsurance, requiring prior authorization for both. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers emergency room visits with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $75,000 limit with a $120 copay and no coinsurance.
Primary Care See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers primary care physician, podiatry, and telehealth services with no copay and no coinsurance. Other services require no coinsurance and copays ranging from $0 to $25, though chiropractic care is only partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Gold Dialysis & Kidney (HMO-POS C-SNP) with no copay and no coinsurance for covered options like annual exams and kidney disease education. Uncovered sub-services include health education, medical nutrition therapy, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) partially covers hearing services, as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered. Routine hearing exams require a $15 copay and no coinsurance, while covered prescription hearing aids have no coinsurance and a copay ranging from no copay to $1,495.
Vision Services See details
Vision services are partially covered by Gold Dialysis & Kidney (HMO-POS C-SNP), with other eye exam services and eyewear upgrades excluded from coverage. Routine eye exams are available with a $15 copay and no coinsurance, while covered eyewear has no copay and no coinsurance, with no deductibles applying to either service.
Dental Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) provides partially covered dental services up to a $5,000 annual maximum, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for most preventive and comprehensive care. While removable prosthodontics require no copay and a 50% coinsurance, other sub-services such as orthodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and other diagnostic dental services are not covered.
Home Infusion bundled Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Gold Dialysis & Kidney (HMO-POS C-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers durable medical equipment and prosthetics or medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic tests with a copay ranging from no copay to $25. Radiological services are partially covered with prior authorization required, featuring no copay for diagnostic radiological services and a minimum 20% coinsurance for therapeutic radiological services, while outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Gold Dialysis & Kidney (HMO-POS C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by the Gold Dialysis & Kidney (HMO-POS C-SNP) plan with a $15 copay, no coinsurance, and required prior authorization. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Gold Dialysis & Kidney (HMO-POS C-SNP) with no coinsurance and no prior three-day inpatient hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20 and a $214 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) provides partial coverage for other services, which includes acupuncture for a $20.00 copay and no coinsurance up to 12 treatments per year, and chronic illness meal benefits with no copay, no coinsurance, and a required referral. Over-the-counter (OTC) items are not covered under this benefit.
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