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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 2025, 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 Memphis. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $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:
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 has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a standard or mail order pharmacy, and a $100 copay for preferred brand drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, and pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying costs. You'll have a $2185 copay for inpatient hospital stays and outpatient services with 20% coinsurance, while emergency services cost $110. Primary care visits have no copay, and specialist visits are $45, but there are also copays for services like chiropractic and occupational therapy. Preventive services and home health have no copay, but hearing, vision, and dental services have copays and may have limits on coverage. Ambulance services have a copay, and transportation to plan-approved locations is covered. The plan also covers services like dialysis, home infusion, and medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $2185.00, and additional days are covered with no copay. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $2036.00, and additional days are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a 20% coinsurance and a copay between $0 and $250, while observation services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient blood services have no copay. Outpatient substance abuse services, including individual and group sessions, have a 20% coinsurance and a copay between $30 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP). Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 40 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $110 copay. Urgently Needed Services have a 20% coinsurance, and also have a maximum per visit amount of $45.
Primary Care See details
Primary Care coverage includes no copay for Primary Care Physician Services, a $15 copay for Chiropractic Services, a $20 copay for Occupational Therapy Services, a $45 copay for Physician Specialist Services, and a $20 copay for Physical Therapy and Speech-Language Pathology Services. Mental Health Specialty Services, and Psychiatric Services have a $30 copay for individual and group sessions, and Podiatry Services and Other Health Care Professional have a copay between $0 and $45. Additional Telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services have a 20% coinsurance and a copay between $30 and $30.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay and Annual Physical Exams with no copay. Additional preventive services, including smoking cessation, fitness benefits and in-home support services, have a copay. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $45 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) have a copay between $199 and $499, while inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$45, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with a $1,500 annual maximum. Medicare dental services have a $45 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, and adjunctive general services have no copay. Prosthodontics, removable and prosthodontics, fixed have a 30% coinsurance, and the plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and between 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0-20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and no copay, while Prosthetics/Medical Supplies and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with some services requiring prior authorization. Diagnostic Procedures/Tests have a maximum copay of $45 and a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have a maximum copay of $45 and a coinsurance of at most 20%. Outpatient X-Ray Services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required, and copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers acupuncture with a $45 copay, up to 20 treatments per year, and also covers over-the-counter items, with a maximum benefit of $1380 per year. This plan provides a meal benefit with no copay. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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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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