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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 Virginia. 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 $19.40. 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 $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 $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 Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan has a $450 deductible for prescription drugs. Once the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, for a standard pharmacy, you will pay a $5 copay for preferred generic drugs, a $47 copay for standard generic drugs, and 35% coinsurance for preferred brand drugs. After your total yearly drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying costs. You'll find no copays for primary care visits, preventive services, and many vision and dental services. The plan includes copays for inpatient hospital stays, outpatient services, and specialist visits, with some services requiring coinsurance. This plan provides coverage for emergency services, hearing exams, and prescription hearing aids. It also covers home health services and skilled nursing facilities, with copays applicable in some instances. Additional benefits include coverage for acupuncture, over-the-counter items, and a meal benefit, but it's important to note that certain services like private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a copay of $399 for days 1-6, and no copay for days 7-90, and Inpatient Hospital Psychiatric, with a copay of $399 for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $450, observation services with a $399 copay, and ambulatory surgical center services with no copay. Outpatient Substance Abuse services are covered with a copay between $50 and $100, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. This benefit has a copay of $80, and prior authorization is required.
Ambulance and Transportation Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers ambulance services with a $315 copay for both ground and air ambulance services, and no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay, and both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay, with no coinsurance.
Primary Care See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a $50 copay, mental health specialty services with a $45 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $25 copay. Additionally, the plan covers additional telehealth benefits with a copay ranging from $0 to $50, and opioid treatment program services with a copay between $50 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services. Additional preventive services, kidney disease education services, and other preventive services are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $699 and $999, while inner ear, outer ear, and over the ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $50, and eyewear with a combined maximum plan benefit coverage amount of $150 per year. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) have no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Restorative services and prosthodontics (removable and fixed) are covered with no copay and 30-40% coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare Dental Services require prior authorization and have a $50 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with a $50 copay and 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying copays and coinsurance. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have no copay and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures, tests, and lab services, and coinsurance for Medicare-covered lab services. Diagnostic Procedures/Tests have a maximum copay of $50.00 and a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325.00, and Therapeutic Radiological Services have a maximum copay of $50.00, with a coinsurance of at most 20%. Outpatient X-Ray Services have no 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, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and the copay for the covered services is listed in the plan details.
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.
Other Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers acupuncture with a $50 copay, but only for a maximum of 20 treatments per year, and also covers over-the-counter (OTC) items with a maximum benefit of $600 per year. The plan also covers a meal benefit with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, or other additional services such as Private Duty Nursing Services.
Get Personalized Help from a licensed insurance agent
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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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