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Gold Dialysis & Kidney Complete (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Dialysis & Kidney 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 Dialysis & Kidney Complete (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Gold Dialysis & Kidney 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 Dialysis & Kidney 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 Dialysis & Kidney 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 Dialysis & Kidney 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 Dialysis & Kidney Complete (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $615.00 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 $9250.00 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 Complete (HMO-POS C-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your medications before your plan coverage begins to pay. While specific drug tier copayments and coinsurance details are not available, understanding this upfront deductible is essential for estimating your yearly healthcare costs. To determine your exact out-of-pocket costs for specific prescriptions, you will need to consult the plan's comprehensive formulary list.
Additional Benefits
The Gold Dialysis & Kidney Complete (HMO-POS C-SNP) plan offers comprehensive coverage designed to minimize out-of-pocket expenses for critical medical services. Beneficiaries will enjoy no copays and no coinsurance for inpatient hospital stays, routine preventive services, home health care, and select transportation benefits. For most outpatient care, primary and specialist visits, dialysis, and medical equipment, the plan features no copay alongside a standard 20% coinsurance. This plan also includes strong supplemental benefits, such as dental and vision coverage with no copays and generous annual allowances. Hearing exams feature no copay with a 20% coinsurance, while prescription hearing aids are fully covered with no copay or coinsurance up to a $1,500 limit. Additionally, Part B insulin drugs are capped at a $35 copay with no coinsurance, ensuring affordable access to essential medications.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Gold Dialysis & Kidney Complete (HMO-POS C-SNP), offering acute and psychiatric stays with no copays and no coinsurance, although prior authorization is required. This benefit does not cover upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services are covered by Gold Dialysis & Kidney Complete (HMO-POS C-SNP) with no copay, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services also require no copay and a 20% coinsurance, with the deductible waived for the first three pints of blood.
Partial Hospitalization See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. The plan also covers up to 24 one-way transportation trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers emergency services with a 20% coinsurance and no copay (up to $115 per visit), which is waived if admitted to the hospital within 24 hours. Urgently needed services also carry a 20% coinsurance and no copay (up to $40), while worldwide emergency, urgent, and transportation services are covered with a $120 copay and no coinsurance up to a $75,000 maximum benefit limit.
Primary Care See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers primary care, specialist, mental health, podiatry, telehealth, and therapy services with no copay and 20% coinsurance. Chiropractic services are partially covered under the plan, offering up to 12 routine care visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, excluding health education, medical nutrition therapy, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Gold Dialysis & Kidney Complete (HMO-POS C-SNP), offering hearing exams with no copay and a 20% coinsurance for routine visits, alongside prescription hearing aids with no copay and no coinsurance up to a $1,500 annual limit. The benefit is partially covered, as over-the-counter hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Gold Dialysis & Kidney Complete (HMO-POS C-SNP) with no copays or deductibles, though other eye exam services and eyewear upgrades are not covered. Covered routine eye exams and contact lenses have a 20% coinsurance, while yearly eyeglasses, frames, and lenses feature no coinsurance up to a $300 maximum limit.
Dental Services See details
Dental services are partially covered by Gold Dialysis & Kidney Complete (HMO-POS C-SNP), featuring Medicare dental services with no copay and a 20% coinsurance, alongside other covered preventive and comprehensive services with no copay and no coinsurance up to a $4,000 annual limit. However, other diagnostic dental services, implants, orthodontics, maxillofacial prosthetics, and fixed or removable prosthodontics are not covered.
Home Infusion bundled Services See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance for diagnostic procedures, lab services, and radiological treatments. Prior authorization is required for all radiological services, including diagnostic, therapeutic, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Gold Dialysis & Kidney Complete (HMO-POS C-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive this care.
Cardiac Rehabilitation Services See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) covers some Cardiac Rehabilitation Services with no copay and prior authorization, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Gold Dialysis & Kidney Complete (HMO-POS C-SNP) with no coinsurance and Medicare-defined copays, though prior authorization is required and additional days beyond the Medicare limit are not covered. Beneficiaries can be admitted to a participating facility without requiring a prior three-day inpatient hospital stay.
Other Services See details
Gold Dialysis & Kidney Complete (HMO-POS C-SNP) offers partial coverage for other services, including acupuncture for up to 12 treatments per year with no copay and 20% coinsurance, and a chronic illness meal benefit with no copay and no coinsurance, which requires a referral. Over-the-counter (OTC) items are not covered.
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