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Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - Diabetes and Heart (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus - Diabetes and Heart (HMO C-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Richmond-Tidewater Area. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus - Diabetes and Heart (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus - Diabetes and Heart (HMO 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 Humana Gold Plus - Diabetes and Heart (HMO 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 Humana Gold Plus - Diabetes and Heart (HMO 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. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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.
This plan has a $450.00 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 $9250.00 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 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) prescription drug plan features an annual drug deductible of $450. Members benefit from no copay on Tier 1 preferred generic and Tier 6 select care drugs when using standard pharmacies or preferred mail order. Tier 2 generic drugs are also highly affordable, with a $5 copay for a one-month supply and no copay for a three-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, though you can save on three-month supplies by using preferred mail order. For higher-tier medications, the plan charges a 47% coinsurance for Tier 4 non-preferred drugs and a 27% coinsurance for Tier 5 specialty drugs. This structure helps you manage your healthcare costs by choosing the most cost-effective pharmacy and mail-order options.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers affordable access to core medical services, featuring no copay for primary care visits and routine preventive care, while specialist visits require a $35 copay. Inpatient hospital stays require a $375 daily copay for the first several days before transitioning to no copay, and emergency room visits carry a $115 copay, with no coinsurance required for these services. Outpatient lab work and home health services are also covered with no copay. For ancillary care, this plan provides routine dental, vision, and hearing benefits with no copays, including a $150 annual vision allowance and up to $1,250 in yearly dental coverage. However, durable medical equipment, diabetic supplies, and dialysis services require a 20% coinsurance with no copay. Over-the-counter items are also covered with no copay, helping members manage their daily health needs.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for subsequent days. Prior authorization is required, and some services such as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay between $0 and $450, observation services cost $375 per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ground and air ambulance services with a $335 copay per trip and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Emergency services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with a $115 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 available with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, alongside specialist visits for a $35 copay and no coinsurance. Therapy services require a $25 copay, while mental health, podiatry, and psychiatric services carry a $35 copay, all with no coinsurance. Chiropractic services are only partially covered, with routine and other chiropractic services excluded from coverage.
Preventive Services See details
Preventive services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, diabetes self-management, glaucoma screenings, digital rectal exams, EKGs, and memory fitness. Additional preventive services are only partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides hearing services with no copay and no coinsurance for routine exams, fitting evaluations, and OTC hearing aids, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $199 to $499 and no coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered services. Covered benefits include one routine eye exam and a $150 annual allowance for contact lenses or eyeglasses (lenses and frames) per year, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other dental services up to a $1,250 annual maximum. Specific sub-services that are not covered include fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and other drugs, require a 0% to 20% coinsurance, while covered insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with 20% coinsurance and no copay. Prior authorization is required for these services, and diabetic supplies are limited to select manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have no coinsurance and a copay between $0 and $120, while therapeutic radiological services require a minimum 20% coinsurance and a $35 minimum copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, as all sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy—are excluded from coverage. Consequently, there is no active copay or coinsurance for these services under the plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, which offers acupuncture with a $35.00 copay and no coinsurance for up to 20 annual treatments requiring prior authorization. Over-the-counter items are covered with no copay and no coinsurance, but meal benefits and other miscellaneous 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
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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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