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Gold Dialysis Complete (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Dialysis 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 Dialysis Complete (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold Dialysis 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 Dialysis 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 Dialysis 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 Dialysis 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 Dialysis Complete (HMO-POS C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.10. 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:
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Drug Coverage
The Gold Dialysis Complete (HMO-POS C-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the cost-sharing for each drug tier. Once your total drug costs reach $2,000, you enter the Catastrophic Coverage Phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $30.10 per month.
Additional Benefits
The Gold Dialysis Complete (HMO-POS C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying coinsurance amounts. Many services, like primary care, hearing exams, and vision exams have a 20% coinsurance. Preventive services are covered with no copay, and the plan also covers dental, home health, and dialysis services. This plan provides additional benefits such as ambulance services with a 20% coinsurance, and transportation services. Prescription hearing aids and a wide range of dental services are also covered. The plan also covers services such as home infusion, medical equipment, and diagnostic and radiological services, each with their own coinsurance and copay amounts.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, which both require prior authorization. For Inpatient Hospital-Acute, you will pay the Medicare-defined coinsurance, and for Inpatient Hospital Psychiatric, you will pay the Medicare-defined copay. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, each with a 20% coinsurance, as well as Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, both with a minimum 20% coinsurance and a maximum 20% coinsurance. Outpatient blood services are covered with a 20% coinsurance, and this plan waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Gold Dialysis Complete (HMO-POS C-SNP) plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to any health-related location are covered for 60 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has a $120 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Gold Dialysis Complete (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 services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Most services require a 20% coinsurance, including primary care, chiropractic, physician specialist, physical therapy, and telehealth.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, 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, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit; however, medical nutrition therapy, wigs for hair loss, weight management programs, alternative therapies, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers, additional sessions of smoking cessation, enhanced disease management, and counseling services are not covered.
Hearing Services See details
Hearing services with the Gold Dialysis Complete (HMO-POS C-SNP) plan include hearing exams with a 20% coinsurance, and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids (all types) are covered, but prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with 20% coinsurance, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered, and there is a maximum plan benefit coverage of $1000 every three months.
Dental Services See details
The Gold Dialysis Complete (HMO-POS C-SNP) plan covers dental services, including a 20% coinsurance for Medicare dental services. Other dental services have a maximum plan benefit coverage of $1000 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 also 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 a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Gold Dialysis Complete (HMO-POS C-SNP) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Gold Dialysis Complete (HMO-POS C-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Gold Dialysis Complete (HMO-POS C-SNP) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Gold Dialysis Complete (HMO-POS C-SNP) plan. While the plan mentions 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, they are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization. The plan follows the Medicare-defined cost share for tier 1, and additional days beyond Medicare-covered stays and non-Medicare-covered stays are not covered.
Other Services See details
The Gold Dialysis Complete (HMO-POS C-SNP) plan covers acupuncture with 20% coinsurance, and up to 12 treatments per year. Over-the-counter items and meal benefits are also covered. Some services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others.
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