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Gold Health (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Health (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 Health (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Gold Health (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 Miami Dade. The overall rating for this plan is not yet available for 2026.
It's important to know that Gold Health (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 Health (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 Health (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 Health (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 $1900.00 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 Health (HMO-POS C-SNP) plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. Under this plan, there is no copay for Tier 1 (Preferred Generic) drugs, Tier 2 (Generic) drugs, and Tier 6 (Select Diabetic Drugs) when filled at standard pharmacies or through standard mail order. For brand-name medications, Tier 3 (Preferred Brand) drugs have a standard pharmacy copay ranging from $40 to $100, though standard mail order offers a flat $40 copay for up to a three-month supply. Tier 4 (Non-Preferred Brand) drugs require a copay between $100 and $250 depending on the supply length, while Tier 5 (Specialty Tier) drugs require a 33% coinsurance for a one-month supply at standard pharmacies.
Additional Benefits
The Gold Health (HMO-POS C-SNP) plan offers robust medical coverage with no copay or coinsurance for primary care visits, telehealth, and preventive services. For inpatient hospital stays, members pay a $50 daily copay for the first 7 days and no copay thereafter, while emergency room visits carry a $120 copay that is waived upon admission. Outpatient services are also highly affordable, featuring no coinsurance and a maximum copay of $50. This plan also includes valuable supplemental benefits, such as up to 24 free one-way transportation trips and a comprehensive dental benefit of up to $4,000 with no copay for preventive care. Vision and hearing services are partially covered, including a $5 copay for routine exams alongside generous allowances for eyewear and prescription hearing aids. However, it is important to note that over-the-counter items and cardiac rehabilitation services are not covered under this plan.
Inpatient Hospital See details
Gold Health (HMO-POS C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $50 daily copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute care days are covered, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Gold Health (HMO-POS C-SNP) outpatient services include ambulatory surgical center visits with no copay and no coinsurance, and outpatient hospital care with a $0 to $50 copay and no coinsurance. Outpatient substance abuse services feature no coinsurance with copays of $15 for group and $25 for individual sessions, while outpatient blood services have no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Gold Health (HMO-POS C-SNP) plan with an $80.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Gold Health (HMO-POS C-SNP), with ground ambulance services requiring a $200 copay and air ambulance services requiring a 20% coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Gold Health (HMO-POS C-SNP) covers emergency services with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay or coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $75,000 maximum with a $120 copay and no coinsurance per service.
Primary Care See details
Gold Health (HMO-POS C-SNP) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $5 copay and no coinsurance. Other services like physical therapy, podiatry, and mental health have copays ranging from $5 to $25 with no coinsurance, though chiropractic care is only partially covered because other non-routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Gold Health (HMO-POS C-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. While additional benefits like fitness programs and in-home safety assessments are covered with no copay and no coinsurance (referral required), services such as health education, weight management, and nutritional/dietary benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Gold Health (HMO-POS C-SNP), offering routine exams and fitting evaluations for a $5.00 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay between $195.00 and $1,395.00, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Gold Health (HMO-POS C-SNP) provides partially covered vision services, including one routine eye exam per year for a $5.00 copay and no coinsurance, while other eye exam services are not covered. Eyewear is also partially covered with no copay and no coinsurance, offering annual allowances of up to $115 for contact lenses and $200 for eyeglasses, frames, or lenses, though upgrades are not covered.
Dental Services See details
Gold Health (HMO-POS C-SNP) offers partially covered dental services up to a $4,000 annual limit, with a $5 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care. While select comprehensive services require a 20% coinsurance and no copay, other benefits like implants, orthodontics, and prosthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Gold Health (HMO-POS C-SNP) with no copay, with prior authorization required. Under this benefit, Medicare Part B chemotherapy and other drugs have a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Gold Health (HMO-POS C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Gold Health (HMO-POS C-SNP), offering durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment is covered with no copay and no coinsurance, but this benefit is only partially covered as diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Gold Health (HMO-POS C-SNP), as outpatient X-ray services are not covered. Covered lab and diagnostic radiological services have no copay and no coinsurance, diagnostic procedures have a $0 to $20 copay with no coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Gold Health (HMO-POS C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Gold Health (HMO-POS C-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Gold Health (HMO-POS C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $214 copay per day for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Gold Health (HMO-POS C-SNP) partially covers other services, offering up to 12 acupuncture treatments yearly for a $20 copay and no coinsurance, as well as chronic illness meal benefits with no copay and no coinsurance with a referral. Over-the-counter (OTC) items are not covered under this plan.
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