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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 Ohio & N KY. 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 $3.00. 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 $200.00 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 $9350.00 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 $200 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you may pay a $17 copay for preferred generic drugs at a standard pharmacy, or 43% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you may have your premium reduced.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying costs. For hospital stays, you'll pay a copay of $475 for the first few days, with no copay after that. Outpatient services have copays ranging from $0 to $475, while primary care visits cost $10. The plan also includes coverage for emergency services with a $110 copay, and offers dental services with a $1,000 annual maximum benefit. Preventive services and home health services have no copay, and you will pay a $35 copay for hearing exams and a $0-$35 copay for vision exams.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $475 copay for days 1-5, and no copay for days 6-90, while for Inpatient Hospital Psychiatric, you will pay a $475 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $475, observation services with a $475 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services have a copay between $35 and $100 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP). Ground and air ambulance services have a $315 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with a $110 copay, and no coinsurance. Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each have a $110 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers primary care physician services with a $10 copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational therapy services have a $35 copay. Physician specialist services have a $35 copay. Individual and group sessions for mental health and psychiatric services have a $35 copay. Physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $45. Opioid treatment program services have a copay between $35 and $100. Other health care professional services have a copay between $10 and $35. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. Annual physical exams have no copay, while other preventive services, and fitness benefits may have a copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, while routine hearing exams are covered with no copay for one exam per year, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, as prescription hearing aids (all types) have a copay between $399 and $999 for two hearing aids per year, but prescription hearing aids - 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 of $0-$35, and eyewear with no copay, including contact lenses and eyeglasses (lenses and frames) with a combined maximum benefit of $100 per year; eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams are covered with no copay, and you are limited to one per year. You are limited to one pair of contact lenses and one pair of eyeglasses (lenses and frames) per year.
Dental Services See details
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan covers dental services, with a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, while restorative services have a $25 copay, and Medicare dental services have a $35 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and authorization required, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have no copay, with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $105, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $720, and Therapeutic Radiological Services have a copay of up to $35 and coinsurance of at least 20%. Outpatient X-Ray Services have a $10 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, but not covered in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under this plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $35 copay, OTC items have a maximum benefit of $420 per year, and the meal benefit has no copay.
Get Personalized Help from a licensed insurance agent
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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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