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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 2026, 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 2026.
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 $22.90. 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 $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 $9250.00 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 features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay for a 1-month or 3-month supply when using a standard pharmacy or preferred mail order. If you utilize standard mail order, Tier 1 drugs carry a $10 to $30 copay, while Tier 2 drugs require a copay of $20 to $60. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance. This 25% cost-sharing rate applies across standard retail pharmacies, preferred mail order, and standard mail order options. While Tier 3 and Tier 4 medications are available in both 1-month and 3-month supplies, Tier 5 specialty drugs are limited to a 1-month supply.
Additional Benefits
The Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan offers robust medical coverage, featuring inpatient hospital stays with a $2,230 copay for acute care and a $2,080 copay for psychiatric care, both with no coinsurance. Most outpatient services, primary care visits, specialist consultations, and durable medical equipment are covered with no copay and a 20% coinsurance. Emergency room visits require a $115 copay, which is waived upon admission, while urgent care services carry a $40 copay. For supplemental care, members benefit from dental services up to a $3,000 annual maximum and vision benefits with a $450 annual allowance for eyewear, both offering options with no copay and no coinsurance. Skilled nursing facility stays require no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Additionally, home health services, select preventive care, over-the-counter items, and chronic illness meals are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,230 copayment per stay for acute care and a $2,080 copayment per stay for psychiatric care. Prior authorization is required for these covered services, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) covers outpatient services with no copay, though a 20% coinsurance and prior authorization typically apply to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Additionally, there is no deductible for outpatient blood services, and the deductible is waived for the first three pints.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) with a $335 copay and no coinsurance for both ground and air transportation, which requires prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered under this plan with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance. While some chiropractic services are covered, routine and other chiropractic services are not covered. Telehealth services are also available with a $0 to $40 copay and a 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, and memory fitness. However, several supplemental options are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and home-based palliative care.
Hearing Services See details
Hearing services covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) include fitting evaluations and OTC hearing aids with no copay or coinsurance, and annual routine exams with a 20% coinsurance and no copay. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Vision services are partially covered with no deductible by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP), which includes one annual routine eye exam with no copay and 20% coinsurance. Covered eyewear has no copay and no coinsurance up to a $450 annual limit for contact lenses and eyeglasses (lenses and frames), but other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) features partially covered dental services with no copay and 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental services up to a $3,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) covers home infusion bundled services, which require prior authorization and step therapy. Under this benefit, Part B insulin drugs require a $35 copay, other Part B drugs have no copay, and chemotherapy or radiation drugs require a copay, with all categories subject to no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) with a 20% coinsurance and prior authorization required. Members will pay no copay for lab services, a copay of $0 to $40 for diagnostic tests, a $15 copay for x-rays and therapeutic radiology, and a minimum $200 copay for diagnostic radiological services.
Home Health Services See details
Home health services are covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) have some services covered with no copay, no coinsurance, and prior authorization required. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and no prior three-day hospital stay is needed, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus SNP-DE H2875-002 (HMO-POS D-SNP), featuring acupuncture with no copay and 20% coinsurance, and over-the-counter items and chronic illness meals with no copay and no coinsurance. Highly integrated services for dual eligible SNPs are not covered, and prior authorization is required for acupuncture and meal benefits.
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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