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Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - Diabetes and Heart (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Jefferson and Orleans Parishes. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus - Diabetes and Heart (HMO 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 Humana Gold Plus - Diabetes and Heart (HMO 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 Humana Gold Plus - Diabetes and Heart (HMO 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. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2500.00 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:
Sign up for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
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Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan features an annual prescription drug deductible of $615, though many common medications are available with no copay. Beneficiaries pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs filled at standard pharmacies or through preferred mail order. Standard mail order for Tier 1 and Tier 2 drugs carries a modest copay, while Tier 6 medications feature no copay across all fulfillment channels. For brand-name and specialized medications, costs are structured as copays or coinsurance depending on the drug tier. Tier 3 preferred brand drugs require a $30 copay for a one-month supply at standard pharmacies or preferred mail order. Meanwhile, Tier 4 non-preferred drugs require a 50% coinsurance, and Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply across all available pharmacy networks.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers comprehensive medical coverage with no copay for primary care visits and a $15 copay for specialist care. Inpatient hospital stays require a $20 daily copay for the first five days followed by no copay, while outpatient hospital services range from no copay to a $100 copay. Routine preventive services, home health care, and laboratory tests are also provided with no copay. This plan also includes valuable supplemental benefits, such as dental coverage up to a $4,000 annual limit with no copay for most preventive and comprehensive services. Vision care features no copay for eyeglasses or contact lenses up to a $550 yearly limit, and routine hearing exams are also covered with no copay. Additionally, members can access up to 60 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers inpatient hospital services with no coinsurance and a $20 daily copay for days 1 to 5, followed by no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $100 copay for outpatient hospital services and a $20 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse sessions require a $15 to $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $25.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with ground ambulance services requiring a $335 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 60 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers primary care physician visits with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Physical, occupational, and speech therapies are covered with a $5 copay and no coinsurance, but chiropractic services are not covered. Mental health, psychiatric, and routine podiatry services are also covered with a $15 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, featuring no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, memory fitness, and in-home support. However, many additional preventive options are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and therapeutic massage.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing exams with no coinsurance, requiring a $15 copay for Medicare-covered exams and no copay for routine annual exams. Prescription hearing aids are partially covered with a copay ranging from $199 to $499 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), featuring no coinsurance for all services, a $0 to $15 copay for eye exams, and no copay for eyeglasses or contact lenses up to a $550 annual limit. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) dental services are partially covered, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $4,000 annual limit. Most preventive and comprehensive services require no copay or coinsurance, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Medicare Part B drugs, including chemotherapy and radiation, are covered with no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, subject to prior authorization. Durable medical equipment and diabetic supplies feature a 20% coinsurance and no copay, prosthetic devices require a 20% coinsurance, and medical supplies and diabetic shoes or inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, though prior authorization is required. There is no copay for lab and outpatient X-ray services, while diagnostic procedures range from a $0 to $65 copay, diagnostic radiological services start at a $0 copay, and therapeutic radiological services have a minimum $15 copay.
Home Health Services See details
Home health services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance and require prior authorization. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers other services, offering acupuncture for a $15 copay and no coinsurance for up to 20 treatments per year, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while some other miscellaneous services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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