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Gold Loyalty (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Loyalty (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Gold Loyalty (HMO-POS) in 2025, please refer to our full plan details page.
Gold Loyalty (HMO-POS) is a HMO-POS plan offered by Gold Kidney Health Plan available for enrollment in 2025 to people living in Counties: GA, MA, PA, PL, CH, CO, GH, and NV. The overall rating for this plan is not yet available for 2025.
It's important to know that Gold Loyalty (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Gold Loyalty (HMO-POS).
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 Loyalty (HMO-POS), 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 $75.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 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
Prescription drugs are not covered by Gold Loyalty (HMO-POS).
Additional Benefits
The Gold Loyalty (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You will pay a copay for services like emergency care, primary care, and specialist visits. The plan also includes benefits for hearing, vision, and dental, with specific allowances for eye exams and dental services. Additional benefits include coverage for ambulance services, home health, and skilled nursing facilities, each with specific cost-sharing requirements. Preventive services are covered, but some services like cardiac rehabilitation are not. The plan also includes a monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-7, and no copay for days 8-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-7, and no copay for days 8-90, with no coinsurance.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $275, observation services with a $300 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient substance abuse services, including individual and group sessions, have a 20% coinsurance, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered with a prior authorization, and the copay is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gold Loyalty (HMO-POS) plan. Ground Ambulance Services have a $250 copay, while Air Ambulance Services have 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Gold Loyalty (HMO-POS) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
The Gold Loyalty (HMO-POS) plan covers primary care physician services, chiropractic services with 20% coinsurance for routine care, occupational therapy with a $35 copay, physician specialist services with a $45 copay, mental health specialty services with a $45 copay for individual and group sessions, podiatry services with a $45 copay, other health care professional services with a $45 copay, psychiatric services with a $45 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a $45 copay, and opioid treatment program services with a $45 copay.
Preventive Services See details
Preventive Services are covered under the Gold Loyalty (HMO-POS) plan. Some additional preventive services are covered, including services not usually covered by Medicare plans, and include coverage for In-Home Safety Assessment, Personal Emergency Response System, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Therapeutic Massage, In-Home Support Services, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, Health Education, 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, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing services with the Gold Loyalty (HMO-POS) plan include routine hearing exams and fitting/evaluation for hearing aids with no copay or coinsurance, and prescription hearing aids (all types) with no copay or coinsurance. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision Services are covered, including routine eye exams, eyewear, and upgrades. Eye exams have a maximum benefit of $625 every three months, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have unlimited benefits.
Dental Services See details
The Gold Loyalty (HMO-POS) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic services, with a maximum plan benefit of $625 every three months. The plan also covers prophylaxis (cleaning), fluoride treatments, and other preventative services. Other covered services include orthodontics, restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Gold Loyalty (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Gold Loyalty (HMO-POS) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Gold Loyalty (HMO-POS) plan, which includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Gold Loyalty (HMO-POS) plan. Diagnostic procedures, tests, and lab services have no copay, but they may have up to 20% coinsurance. Diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have no copay, but they may have up to 20% coinsurance and require prior authorization.
Home Health Services See details
Home Health Services are covered by the Gold Loyalty (HMO-POS) plan with no copay and no 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 Loyalty (HMO-POS) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Gold Loyalty (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Gold Loyalty (HMO-POS) plan's "Other Services" benefit covers over-the-counter items, up to $50 per month. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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