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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 Albuquerque. 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 $3250.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, members enjoy no copay when using standard pharmacies or preferred mail order services. Tier 2 generic medications are also highly affordable, carrying an $8 copay for a one-month supply at standard pharmacies, or no copay for a three-month supply through preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply. Tier 4 non-preferred drugs and Tier 5 specialty drugs require coinsurance rather than a flat copay, costing 50% and 25% coinsurance respectively. Choosing preferred mail order services for multi-month fills is often the most cost-effective way to manage prescription expenses under this plan.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, while specialist visits require a $20 copay. For hospital stays, members pay a $325 daily copay for the first six days of inpatient care and no copay for days 7 through 90. Outpatient hospital services range from no copay to a $325 copay with 20% coinsurance, and emergency room visits carry a $115 copay which is waived if admitted. This plan also includes valuable everyday health benefits, featuring no copay or coinsurance for routine vision exams, select eyewear up to $250 annually, and most preventive and comprehensive dental care up to a $2,000 yearly limit. Additionally, members can access routine hearing exams and over-the-counter hearing aids with no copay, as well as up to 36 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For both acute and psychiatric stays, you will pay a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute days are covered with no copay, but upgrades, non-Medicare-covered stays, 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 copay of $0 to $325 and 20% coinsurance, while ambulatory surgical center and blood services are provided with no copay and no coinsurance. Outpatient substance abuse individual and group sessions are covered with a $25 to $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ambulance services with no coinsurance and a copay of $335 for ground and $630 for air transport. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, while transportation to any other health-related location is not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are 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 $115 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 specialist visits require a $20 copay and no coinsurance. Other covered benefits include physical, occupational, and speech therapies for a $30 copay, mental health and psychiatric care for a $25 copay, and podiatry for a $20 copay, all with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs. However, sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
Hearing Services under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan are covered, offering Medicare-covered exams for a $20 copay and no coinsurance, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $299 to $899 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), offering routine eye exams and select eyewear with no copay, no coinsurance, and no deductible, up to a $250 yearly limit. However, other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers dental services with a $2,000 annual maximum, offering no copay and no coinsurance for most preventive and comprehensive care, though Medicare-covered dental services require a $20 copay and no coinsurance. Fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered under this plan, and prior authorization is required for some services.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay that does not count toward the plan deductible.
Dialysis Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. Durable medical equipment and diabetic supplies require a 20% coinsurance and no copay, prosthetic devices carry a 20% coinsurance, and medical supplies and diabetic therapeutic shoes or inserts are covered 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, offering no copay for outpatient X-rays and lab services alongside a 20% coinsurance. Outpatient diagnostic procedures and tests range from no copay up to a $40 copay with 20% coinsurance, while therapeutic radiological services require both a copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) requires prior authorization for Cardiac Rehabilitation Services where some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. There is no copay for Cardiac and Intensive Cardiac Rehabilitation, and a 20% coinsurance applies to Pulmonary Rehabilitation and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with additional days beyond the standard Medicare-covered period not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers acupuncture with a $20 copay and no coinsurance for up to 20 treatments per year, as well as meal benefits and over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and some CMS-listed over-the-counter drugs are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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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