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Gold Circle Dialysis (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold Circle 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 Circle Dialysis (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold Circle 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, 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 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 Circle 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 Circle 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 Circle 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 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 Dialysis (HMO-POS C-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), you will pay no copay for Part D. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Gold Circle Dialysis (HMO-POS C-SNP) plan offers a variety of services with cost-sharing through coinsurance, including 20% for inpatient hospital, outpatient services, primary care, hearing, vision, and dental services. This plan also covers home infusion services with a $35 copay for Medicare Part B Insulin Drugs, and dialysis services with a 20% coinsurance. Other benefits include no copay for ambulance and transportation services, and home health services, with no coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with prior authorization required. Additional days for inpatient hospital, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered with a 20% coinsurance; Ambulatory Surgical Center (ASC) Services are covered with a coinsurance between 20% and 20%; and Outpatient Substance Abuse Services, including individual and group sessions, are covered 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 Dialysis (HMO-POS C-SNP) plan, but requires prior authorization. The plan has a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Gold Circle Dialysis (HMO-POS C-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Gold Circle Dialysis (HMO-POS C-SNP) plan with a 20% coinsurance, and Urgently Needed Services also have a 20% coinsurance. Worldwide Emergency Services are not covered by this plan.
Primary Care See details
The Gold Circle Dialysis (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. Primary care, chiropractic, physician specialist, physical therapy, speech-language pathology, and additional telehealth services have a 20% coinsurance. Individual and group sessions for mental health and psychiatric services have a 20% coinsurance. Occupational therapy and opioid treatment program services have a 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Gold Circle Dialysis (HMO-POS C-SNP) plan covers Medicare-covered preventive services and additional preventive services, including health education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit; however, the annual physical exam, in-home safety assessment, personal emergency response system, medical nutrition therapy, 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 benefit, 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 Dialysis (HMO-POS C-SNP) plan, with a coinsurance of at most 20% for routine hearing exams, but hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered. There is no deductible.
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 for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, and includes coverage for Medicare Part B Insulin Drugs with a $35 copay. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Gold Circle Dialysis (HMO-POS C-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) and Prosthetics/Medical Supplies covered with 20% coinsurance. Diabetic Equipment is also covered, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, each with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Gold Circle Dialysis (HMO-POS C-SNP) plan. There is no copay for these services, and you may have to pay up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Gold Circle Dialysis (HMO-POS C-SNP) 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 Dialysis (HMO-POS C-SNP) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not provide SNF services as a supplemental benefit under Part C. The plan does not cover additional days beyond Medicare-covered for SNF, or non-Medicare-covered stays for SNF.
Other Services See details
The Gold Circle Dialysis (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, or Self-Directed Personal Assistance Services. The plan covers a meal benefit for chronic illnesses, but does not specify any cost details.
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