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Humana Gold Plus - End Stage Renal Disease (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - End Stage Renal Disease (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 - End Stage Renal Disease (HMO C-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Indiana and 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 - End Stage Renal Disease (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 - End Stage Renal Disease (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 - End Stage Renal Disease (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 - End Stage Renal Disease (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.
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 $590.00 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 $7500.00 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 - End Stage Renal Disease (HMO C-SNP) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay no copay at standard and preferred pharmacies, and a $20.00 copay at standard mail order pharmacies. Standard generic drugs have a $47.00 copay, and preferred and non-preferred brand drugs have 44% and 25% coinsurance, respectively. Specialty tier drugs have no copay at preferred pharmacies and an $11.00 copay at standard mail order pharmacies.
Additional Benefits
The Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan offers a variety of benefits, including inpatient and outpatient hospital services, with varying copays for different services. This plan provides coverage for primary care, preventive services, hearing, vision, and dental services, often with no copay, but some services have limitations or exclusions. Additional benefits include ambulance, emergency, and home health services, as well as coverage for medical equipment and dialysis services. The plan also covers home infusion, diagnostic and radiological services, cardiac rehabilitation, skilled nursing facilities, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a copay of $435 for days 1-5 and no copay for days 6-90, and coverage for Additional Days for Inpatient Hospital-Acute with no copay for days 91-999. Inpatient Hospital Psychiatric benefits are also covered, with a copay of $435 for days 1-4 and no copay for days 5-90, however, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all 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 $435, Observation Services have a $435 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $0 and $100.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $315 copay. Transportation Services to a plan-approved health-related location have no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan covers primary care physician services, physician specialist services, individual and group sessions for mental health and psychiatric services, and other health care professional services with no copay. Chiropractic services have a $15 copay, occupational therapy services have a $10-$35 copay, physical therapy and speech-language pathology services have a $10-$35 copay, and additional telehealth benefits have a $0-$45 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $399 and $999 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services, including Medicare dental services, oral exams, dental x-rays, other diagnostic and preventive services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics, fixed, and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implant services, and orthodontics are not covered. Other dental services have a maximum plan benefit of $1500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and 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 - End Stage Renal Disease (HMO C-SNP) plan. There is no copay for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance; Diabetic Supplies have a 20% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $105, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of at most $525, and Therapeutic Radiological Services have a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan, 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 copay information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan covers acupuncture with no copay, up to 20 treatments per year, and over-the-counter items with a maximum benefit of $1500 per year. The plan also offers a meal benefit with no copay for a chronic illness, but does not cover Dual Eligible SNPs with Highly Integrated Services, or several other services.
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