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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 2026 to people living in Select Counties in Maine. 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 $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 $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 $6845.00 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:
Sign up for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
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Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan features an annual prescription drug deductible of $450. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies and through preferred mail order, as well as no copay for Tier 6 select care drugs. Tier 2 generic medications are also highly affordable, starting with a low $5 copay for a one-month supply at standard pharmacies and preferred mail order. For brand-name and specialized medications, Tier 3 preferred brand drugs carry a $47 copay for a one-month supply. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 27% coinsurance. Utilizing preferred mail-order services can help lower your overall out-of-pocket costs on multi-month supplies for several drug tiers.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, preventive care, and home health services. Specialist office visits require a $30 copay, while inpatient hospital stays require a daily copay for the first seven days and no copay thereafter. Outpatient procedures and emergency services are also covered, with emergency room visits carrying a $115 copay that is waived upon hospital admission. Additionally, this plan provides valuable supplemental benefits, including routine dental, vision, and hearing care with no copay for most basic services. Members can take advantage of a $1,000 annual dental limit, a $250 eyewear allowance, and up to 24 one-way transportation trips per year to approved locations with no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance, while skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization and referrals are required. For acute stays, there is a $325 daily copay for days 1 through 7 and no copay for days 8 and beyond, while psychiatric stays require a $297 daily copay for days 1 through 7 and no copay for days 8 through 90. Non-Medicare-covered stays, room upgrades, 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 copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $575, observation services require a $325 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ambulance services with a $335 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services 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) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical, occupational, and mental health therapy services are covered with a $35 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides partially covered preventive services with no copays and no coinsurance for covered care such as annual physicals, kidney disease education, glaucoma screenings, and a memory fitness benefit. However, several supplemental services are not covered, including health education, in-home safety assessments, weight management programs, nutritional benefits, and telemonitoring.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing services with no deductible, offering routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Medicare-covered exams require a $30 copay and no coinsurance, while prescription hearing aids are partially covered with copays ranging from $0 to $299 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers vision services with no coinsurance, offering routine eye exams and eyewear with copays ranging from $0 to $30. While the plan provides up to $250 annually for contact lenses or combined eyeglasses, other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), with Medicare-covered services requiring a $30 copay and no coinsurance, and other covered services having no copay and no coinsurance up to a $1,000 annual limit. Most preventive and comprehensive services have no copay and no coinsurance, though removable prosthodontics has a 30% coinsurance, and fluoride, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Home Infusion bundled Services with no copay. Medicare Part B chemotherapy, radiation, and other drugs feature coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetic devices, and medical or diabetic supplies with a 20% coinsurance and no copay, subject to prior authorization. Diabetic therapeutic shoes and inserts are covered with a $10 copay and coinsurance, 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 no copay for lab services and outpatient x-rays, and no coinsurance for diagnostic services. Diagnostic procedures and tests have a copay of $0 to $300, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $15 copay. Prior authorization and referrals are required for these services.
Home Health Services See details
Home health services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring prior authorization and a referral. However, in practice, some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers other services, offering acupuncture with a $30 copay and no coinsurance, as well as meals and over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and certain benefits like dual-eligible SNP services and some CMS-listed over-the-counter drugs are not covered.
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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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