A non-government entity
Gold Heart & Diabetes (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold 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 Heart & Diabetes (HMO-POS C-SNP) in 2026, please refer to our full plan details page.
Gold 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: CH, CO, GH, and NV. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Gold 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 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 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 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2750.00 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 (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 (HMO-POS C-SNP) plan offers an Enhanced Alternative prescription drug benefit with no drug deductible. During the initial coverage phase, you pay no copay for Tier 1 preferred generic drugs and Tier 5 specialty drugs at standard retail pharmacies or through standard mail. For other tiers, you will pay a $40 copay for Tier 2 standard generics, a $100 copay for Tier 3 preferred brands, and 33% coinsurance for Tier 4 non-preferred drugs. If you qualify for the low-income subsidy, also known as Extra Help, your Part D premium is reduced to $0. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs.
Additional Benefits
The Gold Heart & Diabetes (HMO-POS C-SNP) plan provides comprehensive medical coverage with no copay for primary care visits, while specialist visits and outpatient services range up to a $25 and $220 copay respectively. Inpatient hospital stays require a $220 daily copay for the first five days, with no copay for days six through 90. Emergency room visits carry a $120 copay, which is waived if you are admitted, while ground ambulance services require a $200 copay. Additional benefits include dental coverage up to a $2,000 annual limit with no copay for preventive care, alongside routine vision and hearing exams that require a $20 copay. The plan also covers up to $200 annually for eyeglasses and offers hearing aid coverage with copays between $195 and $1,395. Medical equipment, dialysis, and therapeutic radiology services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Gold Heart & Diabetes (HMO-POS C-SNP) partially covers inpatient hospital services, requiring a $220 daily copay for days 1 through 5 and no copay or coinsurance for days 6 through 90 of acute and psychiatric stays. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers outpatient services, featuring no copay or coinsurance for ambulatory surgical center services and a 20% coinsurance with no copay for outpatient blood services. Outpatient hospital and observation services require copays ranging from $0 to $220 with no coinsurance, while outpatient substance abuse sessions carry a $15 to $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Gold Heart & Diabetes (HMO-POS C-SNP) plan with an $80 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) partially covers ambulance and transportation services, as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $200 copay with no coinsurance, while air ambulance services require a 20% coinsurance with no copay, both requiring prior authorization.
Emergency Services See details
Emergency services are covered by Gold Heart & Diabetes (HMO-POS C-SNP) with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $75,000 maximum with a $120 copay and no coinsurance.
Primary Care See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers primary care and professional services with copays ranging from no copay up to $25 and no coinsurance. Covered benefits include primary care, specialist visits, physical and occupational therapy, chiropractic, podiatry, mental health, and telehealth services, with prior authorization required for some treatments.
Preventive Services See details
Preventive services are partially covered by Gold Heart & Diabetes (HMO-POS C-SNP), featuring no copay for Medicare-covered zero-dollar preventive services, annual physicals, and fitness benefits. However, several services are not covered, including health education, medical nutrition therapy, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, telemonitoring, and bathroom safety modifications.
Hearing Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) partially covers hearing services with no deductibles and no coinsurance, offering routine hearing exams for a $20 copay and up to two prescription hearing aids per year with a copay ranging from $195 to $1,395. Specific prescription hearing aid types, such as inner, outer, and over the ear, as well as over-the-counter (OTC) hearing aids, are not covered.
Vision Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers annual routine eye exams with a $20 copay and no coinsurance or deductible. Eyewear is partially covered with no copay or coinsurance, offering up to $115 annually for contact lenses and $200 for eyeglasses, frames, and lenses, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by Gold Heart & Diabetes (HMO-POS C-SNP) up to a $2,000 annual maximum, with no coverage for prosthodontics, implants, maxillofacial prosthetics, and orthodontics. Medicare dental services require a $20 copay and no coinsurance, while restorative, endodontic, and periodontic services have no copay and a 20% coinsurance. Preventive care, adjunctive general services, and oral surgery are covered with no copay and no coinsurance.
Home Infusion bundled Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers home infusion bundled services, which require prior authorization and step therapy. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers Dialysis Services with a 20% coinsurance and no copay.
Medical Equipment See details
Gold Heart & Diabetes (HMO-POS C-SNP) partially covers medical equipment, providing durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Prior authorization is required for these covered items, while diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) partially covers diagnostic and radiological services, as outpatient X-ray services are not covered. Lab services have no copay or coinsurance, diagnostic tests require a copay of up to $30 with no coinsurance, diagnostic radiological services require a copay of up to $200 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) covers home health services, though prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Gold Heart & Diabetes (HMO-POS C-SNP) plan, as none of the specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered. Consequently, there are no copays or coinsurance costs for these services.
Skilled Nursing Facility (SNF) See details
Gold Heart & Diabetes (HMO-POS C-SNP) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered and prior authorization is required. Covered days feature no copay for days 1 to 20, a $214 daily copay for days 21 to 100, and no coinsurance.
Other Services See details
Gold Heart & Diabetes (HMO-POS C-SNP) offers partially covered Other Services, featuring acupuncture with a $20 copay and no coinsurance for up to 12 treatments per year, as well as a doctor-referred meal benefit. Over-the-counter items and dual-eligible SNP 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