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Gold Circle Heart & Diabetes (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Circle Heart & Diabetes (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 Circle Heart & Diabetes (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold Circle Heart & Diabetes (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, CH, CO, GH, and NV. The overall rating for this plan is not yet available for 2025.
It's important to know that Gold Circle Heart & Diabetes (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 Circle Heart & Diabetes (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 Circle Heart & Diabetes (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 Circle Heart & Diabetes (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 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 Circle Heart & Diabetes (HMO-POS C-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay no copay for your prescriptions. After the deductible, you will pay the costs for your drugs until your total drug costs reach $2000. Once you reach that amount, you will enter the next coverage phase, where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Gold Circle Heart & Diabetes (HMO-POS C-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including primary care, outpatient, emergency, and preventive services, have a 20% coinsurance. Some benefits, such as ambulance services and home health services, have no copay. The plan provides coverage for hearing, vision, and dental services, but with specific limitations. The plan also covers home infusion services and dialysis services, both with coinsurance. Other services, like medical equipment and diagnostic services, are covered with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days, non-Medicare stays, and upgrades for both are not covered. The plan requires prior authorization and the cost sharing includes coinsurance and deductible, with details available in the plan documents.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, each with a coinsurance between 20% and 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Gold Circle Heart & Diabetes (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 Circle Heart & Diabetes (HMO-POS C-SNP) plan. There is no copay for ambulance services, but there is a 20% coinsurance for both ground and air ambulance services; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered with a 20% coinsurance, and there is no copay; the coinsurance is waived if admitted to the hospital within 24 hours. Urgently Needed Services are covered with a 20% coinsurance and no copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Gold Circle Heart & Diabetes (HMO-POS C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with a 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
The Gold Circle Heart & Diabetes (HMO-POS C-SNP) plan covers Medicare-covered preventive services, with no copay. Additional preventive services include Health Education, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit, while Annual Physical Exams, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post-discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefits, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services are partially covered by the Gold Circle Heart & Diabetes (HMO-POS C-SNP) plan. Hearing exams have a coinsurance of at most 20%, while routine hearing exams and fitting/evaluation for hearing aids are not covered, and prescription and OTC hearing aids are also not covered.
Vision Services See details
Vision services are partially covered, with a 20% coinsurance for eye exams and contact lenses. Routine eye exams, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Gold Circle Heart & Diabetes (HMO-POS C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Gold Circle Heart & Diabetes (HMO-POS C-SNP) plan. Durable Medical Equipment (DME) and Diabetic Supplies have a 20% coinsurance, while Prosthetic Devices also have a 20% coinsurance. Medical Supplies have a 20% coinsurance. The plan does not cover Durable Medical Equipment for use outside the home.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. For Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, you pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Gold Circle Heart & Diabetes (HMO-POS C-SNP) plan with no copay and no 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 Circle Heart & Diabetes (HMO-POS C-SNP) plan. Specifically, 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 not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization. This plan follows Original Medicare for SNF coverage, and does not cover additional days beyond Medicare-covered days or non-Medicare-covered stays.
Other Services See details
The Gold Circle Heart & Diabetes (HMO-POS C-SNP) plan does not cover acupuncture, over-the-counter items, 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. The plan does cover a meal benefit for a chronic illness.
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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