A non-government entity
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 Dallas and Houston areas. 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. 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 $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 $3500.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, members benefit from no copay when using standard pharmacies or preferred mail order services. Tier 2 generics are also highly affordable, with a $5 copay for a one-month supply at standard pharmacies and no copay for a three-month supply via preferred mail order. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply at standard pharmacies and preferred mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs have a 25% coinsurance for a one-month supply across all pharmacy options. Standard mail order is available for most tiers, though it typically carries higher copays or coinsurance.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage with affordable cost-sharing, including no copays or coinsurance for primary care visits and preventive services. If you need specialist care, visits require a low $15 copay, while inpatient hospital stays cost a $225 daily copay for the first six days and no copay thereafter. Emergency room visits carry a $150 copay, which is waived if you are admitted, and urgent care is available for a $65 copay. This plan also features robust supplemental benefits, including routine vision exams and eyewear up to a $200 annual limit with no copay, and dental coverage up to a $1,500 yearly maximum with no copay for most covered services. Additionally, you will pay no copay or coinsurance for routine hearing exams, while durable medical equipment and dialysis services generally require a 20% coinsurance. Other helpful extras like home health services, over-the-counter items, and chronic illness meals are also covered with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $225 daily copay for days 1 through 6 and no copay for days 7 and beyond. While unlimited additional acute care days are covered at no copay, additional psychiatric days beyond 90 days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $225, observation services require a $225 copay per stay, and outpatient substance abuse sessions have a $20 to $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance, with no plan-level deductible applying to these benefits.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) features primary care visits with no copay and no coinsurance, specialist visits with a $15 copay and no coinsurance, and therapy services with a $25 copay and no coinsurance. Mental health services carry a $20 copay and no coinsurance, whereas podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, and a memory fitness benefit with no copays and no coinsurance. This benefit is partially covered, as sub-services such as health education, weight management programs, in-home safety assessments, and nutritional counseling are not covered.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing services with a $15 copay and no coinsurance for Medicare-covered exams, while routine exams, fitting evaluations, and OTC hearing aids have no copays or coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $599, excluding inner ear, outer ear, and over the ear prescription hearing aids which are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers vision services with no coinsurance, providing one routine eye exam and eyewear (contact lenses or eyeglasses) per year with no copay, up to a $200 annual limit. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) up to a $1,500 annual maximum, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
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 and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), with prior authorization required for durable medical equipment, prosthetics, and diabetic supplies. Covered durable medical equipment, prosthetics, medical supplies, and diabetic supplies require a 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts also feature no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with prior authorization and referrals required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests have no coinsurance and a copay of up to $65, and therapeutic radiological services require a minimum $20 copay and 20% coinsurance.
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. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, but some services are covered while cardiac rehabilitation ($15 copay), intensive cardiac rehabilitation ($15 copay), pulmonary rehabilitation ($20 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copayment of $20 for days 1 through 20 and $218 for days 21 through 100. Prior authorization and referrals are required, though a three-day prior hospital stay is not, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers acupuncture with a $15 copay and no coinsurance for up to 20 treatments per year, requiring prior authorization. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though meal benefits require prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved