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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 2026 to people living in Phoenix. 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.
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 $2800.00 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 Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay a $5.00 copay for Tier 1 preferred generics at standard pharmacies or through preferred mail, while Tier 5 specialty tier drugs have no copay. For other tiers, you will pay a $47.00 copay for Tier 2 standard generics, a 50% coinsurance for Tier 3 preferred brands, and a 25% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy can benefit from a reduced Part D premium of zero dollars.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers affordable coverage for core medical services, featuring no copay for primary care visits and a low $15 copay for specialists. Inpatient hospital stays require a $275 daily copay for the first seven days, while subsequent days up to day 90 have no copay. Emergency room visits come with a $150 copay, which is waived if you are admitted, and urgent care visits require a $40 copay. This plan also includes valuable supplemental benefits, such as routine vision exams and eyewear up to a $400 annual limit with no copay. Covered dental services feature no copay up to a $2,000 annual maximum, and routine hearing exams are available for a $15 copay alongside no copay for over-the-counter hearing aids. Additionally, members can access home health services and plan-approved transportation for up to 36 one-way trips per year with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance and a $275 daily copay for days 1-7, followed by no copay for days 8-90 for acute and psychiatric stays. While unlimited additional acute days are covered at no copay, non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient hospital services with a $0 to $275 copay and 20% coinsurance, and observation services with a $275 copay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $25 to $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers ambulance and transportation services with no coinsurance, requiring a $335 copay for ground ambulance and a $630 copay for air ambulance. Plan-approved transportation services are covered with no copay for up to 36 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $40 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) covers primary care physician services with no copay and no coinsurance, while specialists require a $15 copay and no coinsurance. Additional benefits like therapy, psychiatry, and podiatry feature copays ranging from $10 to $25 with no coinsurance, though chiropractic services are only partially covered because routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copays or coinsurance for covered options like annual physicals, glaucoma screenings, and memory fitness. Uncovered services include health education, weight management, nutritional benefits, alternative therapies, therapeutic massage, and in-home safety assessments.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing exams and fitting evaluations for a $15 copay and no coinsurance, while OTC hearing aids are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $299 to $899 and no coinsurance, but inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Vision services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no deductibles or coinsurance, featuring routine eye exams with no copay and other exams with a $0 to $15 copay. Eyewear is partially covered with no copay up to a $400 annual limit, though individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partially covered dental services, with no coverage for fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Covered Medicare dental services require a $15 copay and no coinsurance, while other covered dental services have no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home infusion bundled services, including chemotherapy, radiation, and other Part B drugs with no copay and no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are also covered under this benefit with a $35 copay and no coinsurance to 20% coinsurance, though prior authorization is required.
Dialysis Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers dialysis services with 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), including durable medical equipment, prosthetics, and diabetic supplies, which generally require a 20% coinsurance and no copay. Prior authorization is required for these services, which also cover diabetic therapeutic shoes and inserts with no copay.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required for all benefits. Members pay no copay for lab services, up to a $40 copay and 20% coinsurance for diagnostic tests, no copay and 20% coinsurance for X-rays, and up to a 20% coinsurance or $300 copay for radiological services.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. In practice, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered, meaning there is no copay or coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. There is no copay and no coinsurance for days 1 through 20, followed by a $218 daily copay and no coinsurance for days 21 through 100.
Other Services See details
Other services covered under Humana Gold Plus - Diabetes and Heart (HMO C-SNP) include acupuncture for a $15 copay and no coinsurance, alongside meal benefits and over-the-counter items with no copay or coinsurance. Prior authorization is required for acupuncture and meal benefits, and dual eligible SNP 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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