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Gold Loyalty (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Loyalty (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Gold Loyalty (HMO-POS) in 2025, please refer to our full plan details page.
Gold Loyalty (HMO-POS) is a HMO-POS 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 Loyalty (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Gold Loyalty (HMO-POS).
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 Loyalty (HMO-POS), 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. Additionally, this plan comes with a Part B Premium reduction of $160.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 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
Prescription drugs are not covered by Gold Loyalty (HMO-POS).
Additional Benefits
The Gold Loyalty (HMO-POS) plan offers a variety of benefits with varying costs. Inpatient hospital stays range from a $250 to $300 copay for the first week, and no copay thereafter, with outpatient services incurring copays and coinsurance depending on the service. This plan also includes coverage for primary care, vision, dental, and hearing services, with copays or coinsurance applying to many services. Preventive services have no copay, while emergency services have a $110 copay. The plan also covers home health, skilled nursing facilities, and home infusion services, each with their own cost structures. Additionally, the plan covers medical equipment, diagnostic services, and provides an OTC allowance, while other services like cardiac rehabilitation are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Gold Loyalty (HMO-POS) plan. For Inpatient Hospital-Acute, you'll pay a $250 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, the copay is $300 for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $200, observation services with a $250 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a 20% coinsurance for both individual and group sessions, while outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Gold Loyalty (HMO-POS) plan with prior authorization required. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gold Loyalty (HMO-POS) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by the Gold Loyalty (HMO-POS) plan. Emergency Services have a $110 copay and no coinsurance, while urgently needed services have a $35 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The Gold Loyalty (HMO-POS) plan covers primary care physician services, chiropractic services with 20% coinsurance, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, mental health specialty services with a $45 copay for individual sessions and a $25 copay for group sessions, podiatry services with a $45 copay, other health care professional services with a $45 copay, psychiatric services with a $45 copay for individual sessions and a $25 copay for group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a $45 copay, and opioid treatment program services with 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
The Gold Loyalty (HMO-POS) plan covers preventive services, including an annual physical exam, additional preventive services, kidney disease education services, and other preventive services with no copay. Additional services such as therapeutic massage, fitness benefits, and home and bathroom safety devices and modifications are covered. Certain services, including health education, medical nutrition therapy, wigs for hair loss, weight management programs, alternative therapies, counseling services, enhanced disease management, telemonitoring services, support for caregivers, additional sessions of smoking cessation, and adult day health services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, with a maximum benefit of $625 every three months. Prescription hearing aids (all types) are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Routine eye exams have no copay and are unlimited, while eyewear benefits are covered under the Eye Exams Category 17a.
Dental Services See details
The Gold Loyalty (HMO-POS) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. This plan has a maximum benefit of $625 every three months for dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Gold Loyalty (HMO-POS) plan, including Medicare Part B Insulin Drugs with 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 under the Gold Loyalty (HMO-POS) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits under the Gold Loyalty (HMO-POS) plan include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Medicare-covered diabetic supplies and therapeutic shoes or inserts; durable medical equipment for use outside the home is not covered, and there is no copay for any of these benefits.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Gold Loyalty (HMO-POS) plan. Diagnostic procedures, tests, and lab services have no copay and a coinsurance of at most 20%. Radiological services, including diagnostic, therapeutic, and outpatient X-ray services, have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Gold Loyalty (HMO-POS) plan, with no copay or coinsurance, but prior authorization is required. 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 Loyalty (HMO-POS) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Gold Loyalty (HMO-POS) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $25.00 per month, but does not cover Acupuncture, Meal Benefit, 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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