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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 Kentucky. 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 $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 $150.00 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 $6750.00 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 $150 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you may pay a $5 copay for preferred generic drugs at a preferred pharmacy, or 38% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. However, those who qualify for the low-income subsidy will pay $0 for Part D drugs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. Emergency, primary care, and preventive services are covered, with some services having no copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays and maximum benefit amounts. Additional benefits include coverage for ambulance and transportation services, home health, and cardiac rehabilitation. The plan also covers home infusion and dialysis services, as well as durable medical equipment and diagnostic services. Skilled nursing facility services are covered with copays, and other services such as acupuncture and meal benefits are also included.
Inpatient Hospital See details
Inpatient Hospital benefits cover both acute and psychiatric services, but require prior authorization. For acute care, there is a $480 copay for days 1-5, and no copay for days 6-90, with no coinsurance. For psychiatric care, there is a $480 copay for days 1-4, and no copay for days 5-90, with no coinsurance. Non-Medicare-covered stays and upgrades for inpatient hospital acute services are not covered, and additional days for inpatient hospital psychiatric services are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a copay between $0 and $480, Observation Services have a $480 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have copays between $35 and $100 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered with a $315 copay, and transportation services to a plan-approved health-related location are covered with no copay for up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, 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 $125 copay and no coinsurance, Urgently Needed Services have a $55 copay and no coinsurance, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with no coinsurance for all.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a copay between $10 and $40. Physician Specialist Services have a $35 copay. Mental Health Specialty Services have a $35 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a copay between $10 and $40. Additional Telehealth Benefits have a copay between $0 and $55. Opioid Treatment Program Services have a copay between $35 and $100.
Preventive Services See details
Preventive services include Medicare-covered preventive services, an annual physical exam with no copay, and additional preventive services. The additional preventive services include Fitness Benefit, Kidney Disease Education Services, and other preventive services, and some services have a copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, and routine hearing exams have no copay for 1 exam per year. Fitting/evaluation for hearing aids has no copay, and prescription hearing aids have a copay between $699 and $999 for 2 hearing aids every year; Prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and eyewear with no copay and a combined maximum benefit of $150 per year. Contact lenses and eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery with no copay, and a $2,500 maximum benefit per year. Fluoride treatments, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers durable medical equipment with a 20% coinsurance and requires prior authorization, and covers prosthetic devices, medical supplies, and diabetic equipment. 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, with a minimum copay of $0 and a maximum copay of $105 for Diagnostic Procedures/Tests, and no copay for Lab Services. Diagnostic Radiological Services have a maximum copay of $720, while Therapeutic Radiological Services have a maximum copay of $35 and a minimum coinsurance of 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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
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, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes acupuncture, which has a $35 copay, and meal benefits, which have no copay. 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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* 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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