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Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H3533-002 (HMO 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 H3533-002 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H3533-002 (HMO 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 H3533-002 (HMO 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 H3533-002 (HMO 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 H3533-002 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.40. 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 H3533-002 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, your monthly Part D premium is $27.40. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) plan offers a range of benefits with varying costs. Hospital stays have copays, while outpatient services and partial hospitalization have coinsurance. Emergency services and ambulance services have copays, with no coinsurance. Primary care, preventive services, hearing, vision, and dental services are covered, with varying costs and some services with no copay. This plan also includes home infusion, dialysis, and medical equipment coverage, with coinsurance for most services. Additionally, it covers home health services and skilled nursing facilities, with no copay for the former and a copay for the latter. Other benefits include acupuncture, OTC items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with a copay of $2185 per admission or stay, and Inpatient Hospital Psychiatric with a copay of $2036 per admission or stay; the plan covers additional days for Inpatient Hospital-Acute with no copay, but does not cover Non-Medicare-covered Stay or Upgrades for Inpatient Hospital-Acute, or Additional Days or Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a $250 copay and 20% coinsurance, while Observation Services have a $500 copay. Ambulatory Surgical Center (ASC) Services have a $200 copay and 20% coinsurance. Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization, and you are responsible for 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a copay of $315.00, and there is 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 under the Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $45 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Most services have a 20% coinsurance, and additional telehealth benefits have a copay between $0 and $45. Chiropractic services for routine care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as kidney disease education services and other preventive services that also have no copay. Additional preventive services such as health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and no copay. Prescription hearing aids have no copay, and a plan maximum of $1000 every three years. OTC hearing aids have a $0 copay, and a plan maximum of $1000 every three years.
Vision Services See details
Vision Services include eye exams with 20% coinsurance and no copay, and eyewear with 20% coinsurance, with a combined maximum of $100. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services, and no coinsurance for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, implant services, and oral and maxillofacial surgery are covered with no copay, but other dental services have limitations on the number of visits or the periodicity of the service. Prosthodontics, removable is covered with no copay, but has limitations on the number of visits or the periodicity of the service. Periodontics, maxillofacial prosthetics, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) plan. Insulin has a $35 copay and a coinsurance between 0% and 20%, while the other Part B drugs have a coinsurance between 0% and 20%, and no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit with a 20% coinsurance. Diabetic equipment includes Diabetic Supplies with a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay of up to $45 and a coinsurance of up to 20%, lab services with no copay and a coinsurance of up to 20%, diagnostic radiological services with a copay of $200-$325 and a coinsurance of up to 20%, therapeutic radiological services with a coinsurance of up to 20%, and outpatient X-ray services with no copay and a coinsurance of up to 20%. All services require prior authorization.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus SNP-DE H3533-002 (HMO 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 not in practice. The plan states that Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H3533-002 (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include acupuncture with 20% coinsurance, up to 20 treatments per year, and Over-the-Counter (OTC) Items, with a maximum benefit of $1260.00 per year, and a meal benefit with no copay. Some services are covered, but Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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