A non-government entity
Gold Heart & Diabetes Complete (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Heart & Diabetes Complete (HMO-POS C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Gold Heart & Diabetes Complete (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold Heart & Diabetes Complete (HMO-POS C-SNP) is a HMO-POS C-SNP plan offered by Gold Kidney Health Plan available for enrollment in 2025 to people living in Counties: GA, MA, PA, PL. The overall rating for this plan is not yet available for 2025.
It's important to know that Gold Heart & Diabetes Complete (HMO-POS C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Gold Heart & Diabetes Complete (HMO-POS 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 Gold Heart & Diabetes Complete (HMO-POS 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 Gold Heart & Diabetes Complete (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.90. 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 $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 Gold Heart & Diabetes Complete (HMO-POS 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 Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. If you qualify for the low-income subsidy, you'll pay $10.90 for Part D drugs. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan offers a wide range of benefits with a focus on managing chronic conditions, especially those related to diabetes. The plan covers a variety of services, including primary care, specialist visits, mental health, and dental, with many services requiring a 20% coinsurance. Vision services are also included, along with hearing services with a maximum benefit. This plan also provides coverage for outpatient services, home health, and medical equipment, often with a 20% coinsurance. Emergency and urgent care services have a coinsurance, with worldwide emergency coverage having a copay. The plan also includes additional benefits like acupuncture and an over-the-counter item allowance.
Inpatient Hospital See details
Inpatient hospital coverage includes acute and psychiatric care, but the coinsurance and deductible information are not provided. Additional days, non-Medicare-covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, outpatient blood services, individual sessions for outpatient substance abuse, and group sessions for outpatient substance abuse have a 20% coinsurance. Ambulatory Surgical Center Services and Outpatient Substance Abuse Services have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under the Gold Heart & Diabetes Complete (HMO-POS C-SNP) 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 the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to any health-related location are covered for up to 24 one-way trips per year. Transportation Services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan. Emergency Services have a 20% coinsurance, and Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered by this plan. You will pay 20% coinsurance for Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits. You will pay 20% coinsurance for Medicare-covered Individual Sessions and Group Sessions for Mental Health Specialty Services, and for Medicare-covered Podiatry Services, Routine Foot Care. You will pay a minimum of 20% and a maximum of 20% coinsurance for Occupational Therapy Services, Other Health Care Professional, Individual Sessions and Group Sessions for Psychiatric Services, and Opioid Treatment Program Services.
Preventive Services See details
The Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan covers preventive services, including Medicare-covered preventive services, an annual physical exam, health education, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, therapeutic massage, fitness benefits, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Medical nutrition therapy, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and counseling services are not covered.
Hearing Services See details
Hearing Services are covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan, including hearing exams with a coinsurance of at most 20% and a maximum plan benefit of $1000 every three months. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams and eyewear have a 20% coinsurance, and routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered.
Dental Services See details
Dental Services are covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan, with a 20% coinsurance for Medicare Dental Services, and a maximum benefit of $1000 every three months for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are all covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, while Prosthetics/Medical Supplies and Diabetic Supplies/Therapeutic Shoes/Inserts also have a 20% coinsurance; there is no copay for any of these services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered with no copay, but you may have to pay up to 20% coinsurance. All radiological services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan. Specifically, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. This plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and does not cover additional days beyond Medicare-covered for SNF, nor non-Medicare-covered stays for SNF.
Other Services See details
The Gold Heart & Diabetes Complete (HMO-POS C-SNP) plan covers acupuncture with a 20% coinsurance, up to 12 treatments per year, and also covers over-the-counter items and a meal benefit for chronic illnesses. Other services such as Dual Eligible SNPs with Highly Integrated Services, EPSDT services, and other 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
*/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