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Humana Gold Plus - Diabetes (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - Diabetes (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 (HMO C-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus - Diabetes (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in WA. 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 (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 (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 (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 (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 $2.00. 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 $350.00 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 $7900.00 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 (HMO C-SNP) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay a $10 copay for preferred generic drugs at a preferred pharmacy, or 43% coinsurance for preferred brand drugs. Specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus - Diabetes (HMO C-SNP) plan offers comprehensive coverage with a focus on managing diabetes. This plan includes coverage for inpatient and outpatient hospital services, with varying copays, along with emergency and primary care services with no copay. You can also expect coverage for hearing, vision, and dental services, including exams and eyewear, with no copay for many services. Additional benefits include home health services, skilled nursing facility stays, and medical equipment, all with no copays. This plan also covers diagnostic and radiological services, and preventive services, with no copay for many services. However, it's important to note that services like cardiac rehabilitation, certain home modifications, and specific alternative therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $390 copay for days 1-4, and no copay for days 5-90, while additional days beyond day 90 have no copay.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $390, observation services with a $390 copay, ambulatory surgical center services with no copay, individual and group outpatient substance abuse sessions with a copay between $40 and $50, and outpatient blood services with no copay. Prior authorization and a doctor referral may be required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus - Diabetes (HMO C-SNP) plan, with an $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus - Diabetes (HMO C-SNP) plan. Ground Ambulance Services have a copay of $315, and Air Ambulance Services have a 20% coinsurance; however, 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 by Humana Gold Plus - Diabetes (HMO C-SNP). Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $110 copay, with no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $10 copay, Mental Health Specialty Services with no copay for individual and group sessions, Podiatry Services with a $10 copay, Other Health Care Professional with a copay between $0 and $10, Psychiatric Services with no copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $35 copay, Additional Telehealth Benefits with a copay between $0 and $45, and Opioid Treatment Program Services with a copay between $40 and $50. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for many services, including an annual physical exam with no copay, Additional Preventive Services and Kidney Disease Education Services, which have no copay. Other Preventive Services are covered at no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $10 copay, routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with a copay between $399 and $699 for all types of prescription hearing aids except inner ear, outer ear, and over the ear aids, which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay of $0-$10, and routine eye exams are covered with no copay. Eyewear has no copay, and includes coverage for contact lenses and eyeglasses (lenses and frames), but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus - Diabetes (HMO C-SNP) plan covers Medicare and other dental services, with a $10 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - Diabetes (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. DME has a 20% coinsurance with no copay, and a prior authorization is required. For Prosthetic Devices, there is a 20% coinsurance, and for Medical Supplies there is no copay. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $140, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic radiological services have a copay of up to $390, while therapeutic radiological services have a copay of up to $20 and coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - Diabetes (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus - Diabetes (HMO C-SNP) plan. Although the benefit is generally covered, the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus - Diabetes (HMO C-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and 61-100, but there is a $214 copay for days 21-60.
Other Services See details
Other Services include acupuncture and a meal benefit, both with no copay, but acupuncture requires prior authorization and is limited to 25 treatments per year. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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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