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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 2025, 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 2025.
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 has an enhanced alternative drug benefit with a $0 deductible. In the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy type. For example, preferred generic drugs and specialty tier drugs have no copay at standard and mail order pharmacies. For standard generic drugs, the copay is $40, and for preferred brand drugs, the copay is $100. Non-preferred drugs have a 33% coinsurance. After 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 Health (HMO-POS C-SNP) plan offers a wide array of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. Primary care services have copays ranging from $0 to $25, and preventive services are covered. Additional benefits include coverage for hearing, vision, and dental services with a maximum plan benefit of $625 every three months for each. The plan also provides coverage for ambulance and transportation services, emergency services, and home health services, with specific copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services with a $50 copay for days 1-7 and no copay for days 8-90. Additional days and non-Medicare-covered stays for both services are not covered.
Outpatient Services See details
Outpatient Services with the Gold Health (HMO-POS C-SNP) plan include coverage for all outpatient hospital services with a copay between $0 and $50, and observation services with a $50 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $25 copay for individual sessions and a $15 copay for group sessions. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Gold Health (HMO-POS C-SNP) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gold Health (HMO-POS C-SNP) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation Services to any health-related location are covered for 24 one-way trips per year, using bus/subway, medical transport, or other modes of transportation. Transportation Services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services for Gold Health (HMO-POS C-SNP) include a $90 copay, with no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each with a $120 copay and no coinsurance, with a maximum plan benefit coverage of $75,000. Urgently Needed Services have no copay and no coinsurance.
Primary Care See details
The Gold Health (HMO-POS C-SNP) plan covers primary care, chiropractic, occupational therapy, physician specialist, mental health specialty, podiatry, other health care professional, psychiatric, physical therapy and speech-language pathology, additional telehealth, and opioid treatment program services. This plan has a $20 copay for chiropractic and routine care, a $10 copay for occupational therapy, and a $0-$5 copay for physician specialist services. Mental health individual sessions have a $25 copay, and group sessions have a $10 copay. Podiatry and other health care professional services have a $5-$20 copay depending on the service. Physical therapy and speech-language pathology services have a $10 copay, and telehealth has a $5 copay. Opioid treatment program services have a $25 copay.
Preventive Services See details
Preventive services, including an annual physical exam, are covered. Additional preventive services like health education, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, therapeutic massage, fitness benefits, telemonitoring services, remote access technologies, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered. Medical Nutrition Therapy, 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 of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids with no copay, as well as coverage for prescription hearing aids of all types, but not for inner ear, outer ear, or over the ear hearing aids. The plan offers a maximum of $625.00 for hearing exams every three months, and does not cover OTC hearing aids.
Vision Services See details
Vision services include eye exams with a maximum plan benefit of $625 every three months, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is no copay or coinsurance for any of these services.
Dental Services See details
The Gold Health (HMO-POS C-SNP) plan covers a variety of dental services, including oral exams, x-rays, and cleanings. There is a maximum plan benefit of $625.00 every three months for dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay. The plan covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Gold Health (HMO-POS C-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, with no copay. Durable Medical Equipment (DME) has a 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, but there is no copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Gold Health (HMO-POS C-SNP) plan. Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $50.00, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Gold Health (HMO-POS C-SNP) plan with no copay and no coinsurance, though authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Gold Health (HMO-POS C-SNP) plan. However, 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 Health (HMO-POS C-SNP) plan, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100; however, additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
The Gold Health (HMO-POS C-SNP) plan covers acupuncture with a $20 copay for up to 12 treatments per year, over-the-counter items, and meal benefits for chronic illnesses. The plan does not cover Dual Eligible SNPs with Highly Integrated Services and other services including, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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