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Gold Dialysis & Kidney (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Dialysis & Kidney (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 (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Gold Dialysis & Kidney (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 Dialysis & Kidney (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 (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 (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 (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 & Kidney (HMO-POS C-SNP) Medicare plan features a $0 drug deductible, allowing your prescription drug coverage to begin immediately. You will pay no copay for Tier 1 preferred generic drugs and Tier 6 select diabetic drugs filled through standard pharmacies or standard mail order. Tier 2 generic drugs are available for a low $5 copay for a one-month supply, with standard mail order offering a flat $5 copay for up to a three-month supply. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard pharmacies, or a flat $40 copay through standard mail order. Tier 4 non-preferred brand drugs carry a $100 copay for a one-month supply, while Tier 5 specialty drugs require a 33% coinsurance. Utilizing standard mail order for multi-month fills of Tier 2 and Tier 3 prescriptions provides additional cost savings under this plan.
Additional Benefits
The Gold Dialysis & Kidney (HMO-POS C-SNP) plan offers robust coverage tailored for specialized care, highlighted by fully covered dialysis services with no copay and no coinsurance. Routine healthcare needs are highly affordable, featuring no copay or coinsurance for primary care visits, telehealth services, and annual preventive screenings. For hospital stays, inpatient acute care requires a fifty dollar daily copay for the first seven days and no copay for days eight through ninety. This plan also includes extensive supplemental benefits, such as comprehensive dental coverage up to a five thousand dollar annual limit with no copay or coinsurance for most services. Vision and hearing benefits feature low five dollar exam copays, alongside generous allowances for corrective eyewear and covered hearing aids. Additionally, members can access up to twenty-four one-way transportation trips per year to plan-approved locations with no copay or coinsurance.
Inpatient Hospital See details
Gold Dialysis & Kidney (HMO-POS C-SNP) partially 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. Prior authorization is required, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Gold Dialysis & Kidney (HMO-POS C-SNP) feature no coinsurance for outpatient hospital, ambulatory surgical, and substance abuse services. Ambulatory surgical center services have no copay, outpatient hospital and observation copays range from $0 to $50, substance abuse sessions carry a $15 to $25 copay, and outpatient blood services require no copay with a 20% coinsurance.
Partial Hospitalization See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers partial hospitalization services with an $80.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers ground ambulance services with a $220 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Gold Dialysis & Kidney (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.
Primary Care See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers primary care and telehealth services with no copay and no coinsurance, while other services like specialist, therapy, and mental health visits require copays ranging from $0 to $25 and no coinsurance. Chiropractic services are partially covered, with routine care requiring a $20 copay and no coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Gold Dialysis & Kidney (HMO-POS C-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered under this plan, excluding health education, medical nutrition therapy, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, tobacco cessation, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Gold Dialysis & Kidney (HMO-POS C-SNP), offering routine hearing exams for a $5 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay up to $1,495 for up to two aids per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) partially covers vision services, offering one routine eye exam per year for a $5.00 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to $115 for contact lenses and $300 for eyeglasses annually, while upgrades are not covered.
Dental Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) offers partially covered dental services up to a $5,000 annual limit, with no copay and no coinsurance for most preventive and comprehensive services, a $5.00 copay and no coinsurance for Medicare-covered dental, and a 50% coinsurance and no copay for removable prosthodontics. Other diagnostic services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Under this plan, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are fully covered under the Gold Dialysis & Kidney (HMO-POS C-SNP) plan with no copay and no coinsurance.
Medical Equipment See details
Medical equipment is covered by Gold Dialysis & Kidney (HMO-POS C-SNP), offering durable medical equipment (DME) and prosthetics with no copay and a 20% coinsurance. While diabetic equipment is technically covered with no copay or coinsurance, 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 Dialysis & Kidney (HMO-POS C-SNP), as outpatient X-ray services are not covered. Covered diagnostic procedures and tests carry a $0 to $10 copay and no coinsurance, lab services have no copay or 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 Dialysis & Kidney (HMO-POS C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Gold Dialysis & Kidney (HMO-POS C-SNP) with no coinsurance and no copay for covered services, although prior authorization is required. Some services are covered, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Gold Dialysis & Kidney (HMO-POS C-SNP) with no coinsurance and do not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $214 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Gold Dialysis & Kidney (HMO-POS C-SNP) provides partial coverage for other services, which includes up to 12 acupuncture treatments per year for a $20.00 copay and no coinsurance, plus chronic illness meal benefits with no copay and no coinsurance upon referral. Over-the-Counter (OTC) items are not covered under this plan.
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