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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 Austin and East Texas 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 $3900.00 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. Beneficiaries can enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at standard pharmacies or through preferred mail order. For standard mail order, Tier 1 and Tier 2 drugs carry copays ranging from $10 to $60 depending on the tier and supply. For Tier 3 preferred brand drugs, copays are $47 for a one-month supply, though a three-month preferred mail order reduces the cost to $94. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers affordable coverage with no copay for primary care visits and a low $15 copay for specialist appointments. For inpatient hospital stays, members pay a $260 daily copay for the first five days and no copay for days six through 90. Emergency room visits require a $150 copay, which is waived if you are admitted within 24 hours, while routine home health services are available with no copay. This plan also features strong supplemental benefits, including no copay for routine vision and hearing exams, alongside a $250 annual allowance for eyewear. Dental care is covered with no copay for most services up to a $1,750 yearly limit, though Medicare-covered dental services require a $15 copay. Additionally, members can take advantage of up to 24 routine transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $260 daily copay for days 1 through 5, and no copay for days 6 through 90. However, the benefit is partially covered as psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered, and prior authorization and referrals are required.
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 blood services. Outpatient hospital services have a copay of $0 to $225, observation services require a $260 copay per stay, and outpatient substance abuse sessions have a $25 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 these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), with ground ambulance services requiring a $335 copay (no coinsurance) and air ambulance services requiring a 20% coinsurance (no copay). Routine transportation is partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
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.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, and mental health therapies require a $25 copay and no coinsurance, while podiatry is not covered and only some chiropractic services are covered, excluding routine and other chiropractic care.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partially covered preventive services with no copays and no coinsurance for covered benefits like annual physical exams, kidney disease education, memory fitness, glaucoma screenings, and diabetes self-management training. Supplemental services such as health education, weight management programs, in-home safety assessments, and nutritional benefits are not covered.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers hearing services with no deductible, featuring routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Medicare-covered exams require a $15 copay and no coinsurance, while prescription hearing aids are partially covered with a $599 to $899 copay and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers vision services with no deductibles or coinsurance, featuring routine eye exams with no copay and other exams for a $0 to $15 copay. Eyewear is partially covered with no copay up to a $250 annual limit for one pair of eyeglasses or contact lenses, though individual lenses, frames, upgrades, and other exam services are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers partially covered dental services with a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $1,750 yearly limit. Sub-services that are not covered under this plan include fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
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 referrals are required for these covered services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, though prior authorization is required for most equipment and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services, with prior authorization and referrals required. Members pay no copay or coinsurance for lab services and diagnostic radiology, while outpatient X-rays have no copay, diagnostic procedures have a $0 to $65 copay, and therapeutic radiology requires a minimum 20% coinsurance and a $20 copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance. Members should be aware that both prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, as all primary sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are listed as not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers other services including acupuncture with a $15 copay and no coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance. This benefit is partially covered as prior authorization is required for acupuncture and meals, and it excludes certain over-the-counter drugs as well as other unspecified services.
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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