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Gold Dialysis (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Dialysis (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 (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold Dialysis (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 Dialysis (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 (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 (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 (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 Dialysis (HMO-POS C-SNP) plan has an enhanced alternative drug benefit. The plan has a $0 deductible. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $5 at standard or mail order pharmacies. For standard generic drugs, the copay is $47 at standard pharmacies and $40 at mail order pharmacies. For preferred brand drugs, the copay is $100 at both standard and mail order pharmacies. For non-preferred drugs, you pay 33% coinsurance. For specialty tier drugs, there is no copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Gold Dialysis (HMO-POS C-SNP) plan offers a comprehensive suite of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with varying copays, and ambulance services. This plan also covers a wide array of services such as primary care, preventive care with no copay, hearing and vision services, and dental services, all with specific copays or maximum benefit amounts. Additionally, the plan includes home infusion services, dialysis services with no cost, and medical equipment with coinsurance, along with home health services and skilled nursing facility stays with copays.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by the Gold Dialysis (HMO-POS C-SNP) plan. For days 1-7, there is a $50 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services include all outpatient hospital services with a copay between $0 and $50, observation services with a $50 copay, ambulatory surgical center services with no copay, individual and group sessions for outpatient substance abuse with a copay between $15 and $25, and outpatient blood services with 20% coinsurance. Prior authorization is required for outpatient hospital services, observation services, and ambulatory surgical center services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Gold Dialysis (HMO-POS C-SNP) plan, and requires prior authorization. You will pay a copay of $80 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan. Ground ambulance services have a $200 copay, and air ambulance services have 20% coinsurance. Transportation services to any health-related location are covered for up to 72 one-way trips per year using various modes of transportation.
Emergency Services See details
Emergency Services are covered under the Gold Dialysis (HMO-POS C-SNP) plan, with a $90 copay and no coinsurance, and Urgently Needed Services are covered with no copay and no coinsurance. Worldwide Emergency Services are also covered, with a $120 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, and a maximum plan benefit coverage amount of $75,000.
Primary Care See details
The Gold Dialysis (HMO-POS C-SNP) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $10 copay, Physician Specialist Services with a $0-$5 copay, Mental Health Specialty Services with a $25 copay for individual sessions and a $10 copay for group sessions, Podiatry Services with a $5 copay, Other Health Care Professional with a $20 copay, Psychiatric Services with a $25 copay for individual sessions and a $10 copay for group sessions, Physical Therapy and Speech-Language Pathology Services with a $10 copay, Additional Telehealth Benefits with a $5 copay, and Opioid Treatment Program Services with a $25 copay. Routine Chiropractic Care is limited to 12 visits per year.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, Annual Physical Exams, 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 Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs with no copay. Medical Nutrition Therapy, Wigs for Hair Loss, 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 includes coverage for hearing exams, Routine Hearing Exams, and Fitting/Evaluation for Hearing Aids, with a maximum benefit of $625 every three months, but does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, or OTC Hearing Aids. Prescription Hearing Aids (all types) are covered.
Vision Services See details
Vision services are covered, including routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is a maximum plan benefit coverage of $625 every three months for eye exams.
Dental Services See details
The Gold Dialysis (HMO-POS C-SNP) plan covers Dental Services with a maximum plan benefit of $625 every three months. Oral exams, dental x-rays, and other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, 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 are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no copay or coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance, all with no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan. Diagnostic procedures and lab services are not covered, while diagnostic radiological services have a copay of at most $50, and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Gold Dialysis (HMO-POS C-SNP) plan. While Cardiac Rehabilitation Services are generally covered, this plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Gold Dialysis (HMO-POS C-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Gold Dialysis (HMO-POS C-SNP) plan covers acupuncture with a $20 copay for up to 12 treatments per year. Over-the-counter items and a meal benefit for chronic illness are also covered. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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