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Gold Dialysis (HMO-POS C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Gold 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 Dialysis (HMO-POS C-SNP) in 2025, please refer to our full plan details page.
Gold 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: CH, CO, GH, and NV. The overall rating for this plan is not yet available for 2025.
It's important to know that Gold 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 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 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 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 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 (HMO-POS C-SNP) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay different copays for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a standard pharmacy or $47 for standard generic drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Gold Dialysis (HMO-POS C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services can have copays from $0 to $175, and some services have coinsurance. The plan covers primary care, mental health, vision, and dental services, with copays and maximum benefit amounts for some. The plan also includes coverage for emergency services, ambulance, home health, and skilled nursing facilities, often with copays or coinsurance. Preventive services and dialysis services have no copay, while durable medical equipment and some drugs have coinsurance. Other services such as acupuncture and over-the-counter items are included, with specific copays or limitations.
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 $175 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $175 copay for days 1-7, and no copay for days 8-90. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $0 to $175, and observation services with a $175 copay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services include a $25 copay for individual sessions, and a $15 copay for group sessions. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Gold Dialysis (HMO-POS C-SNP) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan, with prior authorization required for all ambulance services. Ground Ambulance Services have a $200 copay, while Air Ambulance Services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $120 copay, while Urgently Needed Services has a $40 copay; all services have no coinsurance.
Primary Care See details
The Gold Dialysis (HMO-POS C-SNP) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $10 copay, physician specialist services with a $0 - $15 copay, mental health specialty services with a $25 copay for individual sessions and a $10 copay for group sessions, podiatry services, other health care professional services with a $20 copay, psychiatric services with a $25 copay for individual sessions and a $10 copay for group sessions, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits with a $10 copay, and opioid treatment program services with a $25 copay. Routine chiropractic care has a $20 copay for up to 12 visits per year.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered. Additional preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Therapeutic Massage, Fitness Benefit, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered. However, Medical Nutrition Therapy (MNT), 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, and Counseling Services are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no copay. Prescription hearing aids are covered, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. There is a maximum plan benefit coverage of $500.00 for hearing exams every three months.
Vision Services See details
Vision services are covered under the Gold Dialysis (HMO-POS C-SNP) plan, including eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), and upgrades. There is a maximum plan benefit coverage of $500 every three months for eye exams.
Dental Services See details
The Gold Dialysis (HMO-POS C-SNP) plan covers dental services with a maximum plan benefit of $500 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 covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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 with this plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, as well as Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Gold Dialysis (HMO-POS C-SNP) plan. Diagnostic Procedures/Tests, and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $75, while Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Gold Dialysis (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 covered, but specific services like 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. There is a copay for some services, but the details of the copay are not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Gold Dialysis (HMO-POS C-SNP) plan covers acupuncture with a $20 copay, and up to 12 treatments per year. Over-the-counter items and a meal benefit for chronic illness are also covered. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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