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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 2025, 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 Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $4.00. 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 $495.00 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:
Sign up for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
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Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan has a $495 deductible for prescription drugs. After the deductible is met, your costs will vary depending on the drug tier and pharmacy you use. For example, you will pay a $17 copay for preferred generic drugs at a standard pharmacy, and a 43% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), you will pay no cost for Part D drugs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays require a copay, while outpatient services like ambulatory surgical centers and outpatient blood services have no copay. Emergency and primary care services have copays, and preventive services like annual physical exams are covered with no copay. The plan also includes coverage for hearing, vision, and dental services with copays for some services. Home health, skilled nursing, and cardiac rehabilitation services are covered with no copay for some services. Additionally, the plan provides coverage for home infusion, dialysis, and medical equipment with coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-6, and no copay for days 7-90, while additional days 91-999 have no copay. For Inpatient Hospital Psychiatric, you will pay a $395 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $395, Observation Services with a $395 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $40 and $100 for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $315 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Emergency services have a $100 copay, urgently needed services have a $45 copay, and worldwide emergency coverage, urgent coverage, and transportation each have a $100 copay.
Primary Care See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers Primary Care Physician Services with a $10 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $10-$35 copay, Physician Specialist Services with a $45 copay, and Mental Health Specialty Services with a $40 copay for individual and group sessions. The plan also covers Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $10-$35 copay, Additional Telehealth Benefits with a $0-$45 copay, and Opioid Treatment Program Services with a $40-$100 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services are covered with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit. Other services like health education, in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $45 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered with a copay between $399 and $999 for Prescription Hearing Aids (all types), but not covered for inner, outer, or over the ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers vision services, including routine eye exams with a copay between $0 and $45, and eyewear with no copay, but does not cover eyeglass lenses, eyeglass frames, or upgrades. Contact lenses and eyeglasses (lenses and frames) are covered.
Dental Services See details
Dental services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with a $45 copay for Medicare Dental Services. Oral exams, dental X-Rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Restorative services have a $25 copay, and adjunctive general services have no copay. Fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. The plan has a maximum benefit of $1,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. You will pay a $35 copay for Medicare Part B Insulin Drugs with a coinsurance between 0% and 20% for all services.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. This plan requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $105, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $350, and Therapeutic Radiological Services have a coinsurance up to 20% and a copay up to $45. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required for this benefit, and there is a copay for some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers acupuncture with a $45 copay and a limit of 20 treatments per year. Over-the-counter items are covered up to $420 per year, and the plan also covers a meal benefit with no copay. However, 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 are not covered.
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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.
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