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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 Virginia. 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 $8.00. 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 $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. For Tier 1 preferred generic and Tier 6 select care drugs, you will pay no copay for a 1-month or 3-month supply when using a standard pharmacy or preferred mail order. Tier 2 generic drugs are also highly affordable, costing only a $5 copay for a 1-month supply at standard pharmacies, with no copay for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options, though you can save on a 3-month supply by using preferred mail order for a $94 copay. Higher-tier medications are subject to coinsurance rather than flat copays, which includes a 50% coinsurance for Tier 4 non-preferred drugs and a 27% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For specialized care, members pay a $50 copay for specialist visits, while inpatient hospital stays require a $375 daily copay for the first several days before transitioning to no copay. Emergency room visits carry a $115 copay, which is waived if you are admitted, and urgent care is available for a $40 copay. Routine dental, vision, and hearing exams are available with no copay, though advanced services like prescription hearing aids or durable medical equipment require specific copays or a 20% coinsurance. Diagnostic lab work and outpatient X-rays are also covered with no copay, helping to keep your routine diagnostic screenings affordable. Additionally, this plan offers covered over-the-counter items and acupuncture services to further support your overall wellness.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partially covered 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, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have copays ranging from no copay to $450, observation services require a $375 copay per stay, and outpatient substance abuse sessions carry a $35 copay, with prior authorization required for most services.
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. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan cover ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Routine transportation services to plan-approved or other health-related locations are not covered.
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 covered 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, and specialist visits for a $50 copay and no coinsurance. Therapy and mental health services are covered with copays ranging from $25 to $35 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance for covered options like annual physicals, kidney education, glaucoma screenings, and memory fitness. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home modifications, and counseling services.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing services with no coinsurance, offering a $50 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with copays ranging from $699 to $999, 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) provides partially covered vision services with no coinsurance, no deductible, and copays ranging from no copay to $50.00 for eye exams. While one annual routine exam and one pair of eyeglasses or contact lenses are covered with no copay up to a $150 yearly limit, 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) offers partially covered dental services, requiring a $50 copay and no coinsurance for Medicare-covered dental care, and no copay and no coinsurance for other covered preventive and diagnostic services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay, subject to prior authorization. Associated Medicare Part B drugs, including chemotherapy, insulin, and other drugs, carry a coinsurance of 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or supplies with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), with prior authorization required for all services. Lab services, diagnostic radiological services, and outpatient X-rays feature no copay, while diagnostic procedures cost between a $0 to $120 copay with 20% coinsurance, and therapeutic radiological services require a $50 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides Cardiac Rehabilitation Services with no copay and no coinsurance. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), offering acupuncture with a $50 copay and no coinsurance for up to 20 treatments per year, and over-the-counter items with no copay and no coinsurance. Meal benefits are not covered under this benefit.
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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