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Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-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 SNP-DE H2875-002 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Virginia. The overall rating for this plan is not yet available for 2025.
It's important to know that Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-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 SNP-DE H2875-002 (HMO-POS D-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 SNP-DE H2875-002 (HMO-POS D-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 SNP-DE H2875-002 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.70. 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 a $590.00 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 $9350.00 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 Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay for your drugs based on the plan's formulary. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $30.70. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan provides comprehensive coverage with a variety of benefits. This plan covers inpatient hospital stays, outpatient services, and emergency care. It also includes coverage for primary care, preventive services, hearing, vision, and dental services. This plan offers additional benefits, such as home health services with no copay, ambulance services with a copay, and coverage for medical equipment and home infusion services. There is also coverage for dialysis services, cardiac rehabilitation, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP), including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, the copay is $2185 per admission or stay, and additional days are covered with no copay. Inpatient Hospital Psychiatric has a copay of $2036 per admission or stay; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, and Outpatient Substance Abuse Services with a 20% coinsurance for both Individual and Group Sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $315 copay for both Ground and Air Ambulance Services and no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP). Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency, Urgent, and Transportation services all have a $110 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Most of these services have a 20% coinsurance, while additional telehealth benefits have a copay between $0 and $45.
Preventive Services See details
Preventive services, including an annual physical exam, are covered with no copay. Some additional preventive services, like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following a Welcome Visit, are covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered, with a coinsurance of 20% for routine hearing exams. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered, with no copay for prescription hearing aids (all types), but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with routine eye exams covered with no copay and 20% coinsurance, while eyewear has no copay and a combined maximum benefit of $300 per year. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a $3,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan, but require prior authorization. The coinsurance for these services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a coinsurance of at most 20% and a copay of at most $15, and Lab Services with a coinsurance of at most 20% and no copay. Additionally, Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $325, Therapeutic Radiological Services have a coinsurance of at most 20% and a copay of at most $15, and Outpatient X-Ray Services have a coinsurance of at most 20% and a copay of $15.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP), but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $214 copay. Additional days beyond Medicare coverage and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services," this plan covers acupuncture with a 20% coinsurance after prior authorization, and a meal benefit with no copay after prior authorization. Over-the-counter items are covered with a maximum benefit of $1200 per year. Some services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others.
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