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Gold Dialysis (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Dialysis (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 Dialysis (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold Dialysis (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 Dialysis (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 Dialysis (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 Dialysis (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 Dialysis (HMO-POS 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 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:
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Drug Coverage
The Gold Dialysis (HMO-POS C-SNP) plan has an enhanced alternative drug benefit. The plan has no deductible. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $5.00 at standard pharmacies and $5.00 at standard mail order. For standard generic drugs, the copay is $47.00 at standard pharmacies and $40.00 at standard mail order. Preferred brand drugs have a $100.00 copay at both standard pharmacies and standard mail order. Non-preferred drugs have a 33% coinsurance at standard pharmacies. There is no copay for specialty tier drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Gold Dialysis (HMO-POS C-SNP) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay of $175 per day for the first five days, and no copay for the following days, while outpatient services have copays that vary between $0 and $175. Other services include coverage for ambulance, emergency, and primary care services, with copays ranging from $10 to $200. Preventive, hearing, vision, dental, dialysis, and home health services are also covered. Hearing exams and hearing aid fittings have no copay, and vision services cover up to $500 every three months for eye exams. Dental services are covered with a maximum benefit of $500 every three months. Additionally, the plan covers dialysis services with no associated copays or coinsurance, and home health services with no copay or coinsurance, but requires prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $175 per day for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $175, and observation services with a $175 copay. Ambulatory Surgical Center (ASC) Services have no copay, while Outpatient Substance Abuse Services have a copay of $25 for individual sessions and $15 for group sessions. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Gold Dialysis (HMO-POS C-SNP) plan, but requires prior authorization. You will have an $80 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are covered for 50 one-way trips every three months.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $120 copay, while Urgently Needed Services have a $40 copay; all have no coinsurance.
Primary Care See details
The Gold Dialysis (HMO-POS C-SNP) plan covers 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. Chiropractic and Routine Chiropractic Care have a $20 copay; Occupational Therapy Services have a $10 copay; Physician Specialist Services have a copay between $0 and $15; Individual and Group Sessions for Mental Health and Psychiatric Services have a minimum copay of $25 and $10 respectively; Physical Therapy and Speech-Language Pathology Services and Additional Telehealth Benefits have a $10 copay; and Opioid Treatment Program Services have a minimum copay of $25.
Preventive Services See details
The Gold Dialysis (HMO-POS C-SNP) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, 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 screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Medical Nutrition Therapy, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Adult Day Health Services, Nutritional/Dietary Benefit, 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 includes routine hearing exams and fitting/evaluation for hearing aids with no copay, and prescription hearing aids (all types) are covered, but prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear, and OTC hearing aids are not covered. The plan covers up to $500 for hearing exams every three months.
Vision Services See details
Vision services are covered, including routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is no deductible for any of these services, and the plan covers up to $500 every three months for eye exams.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $500 every three months. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Gold Dialysis (HMO-POS C-SNP) plan, with no copay and a 20% coinsurance for Durable Medical Equipment (DME), as well as Prosthetic Devices and Medical Supplies. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan. Diagnostic procedures and lab services are not covered, while Diagnostic Radiological Services have a copay of at most $75.00, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan, with no copay or coinsurance, but authorization is required. 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 Dialysis (HMO-POS C-SNP) plan. Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $20 copay, over-the-counter items, and a meal benefit for chronic illness. However, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services are not covered.
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