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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 2025 to people living in Ohio & N KY. This plan received an overall rating of 3.5 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 $340.00 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 $9150.00 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 features an annual drug deductible of $340 and offers excellent savings on generic medications. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs when using standard pharmacies or preferred mail order services. Tier 2 generic drugs are also highly affordable, with a $5 copay for a one-month supply at standard pharmacies and no copay for a three-month supply filled through preferred mail order. For higher-tier medications, Tier 3 preferred brands require a $47 copay for a one-month supply at standard pharmacies and mail-order services. Tier 4 non-preferred drugs and Tier 5 specialty drugs require coinsurance rather than flat copays, costing 48% and 29% coinsurance respectively. Utilizing standard pharmacies and preferred mail order options can help you maximize your benefits and minimize out-of-pocket prescription expenses.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, home health services, and annual preventive screenings. For more intensive care, inpatient hospital stays require a $475 daily copay for the first several days, while emergency room visits carry a $115 copay with no coinsurance. Specialist visits, physical therapy, and mental health services are also accessible with affordable copays ranging from $30 to $35. Members also benefit from essential routine dental, vision, and hearing care with no copays, including a $300 annual allowance for eyewear and a $1,000 limit on preventive dental. While standard diagnostic lab tests and X-rays have no copays, specialized medical equipment and dialysis services require a 20% coinsurance. Additionally, this plan offers extra benefits like acupuncture, over-the-counter items, and chronic illness meals with no copays.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient hospital services with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $475 daily copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays require a $475 daily copay for days 1 through 4 and no copay for days 5 through 90, with upgrades and non-Medicare-covered stays not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with a copay ranging from $0 to $475 and outpatient substance abuse sessions with a $30 to $35 copay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for most outpatient services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Non-emergency transportation services to health-related locations are not covered under this plan.
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 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) provides primary care physician services with no copay and no coinsurance, while specialist, mental health, and psychiatric services require a $30 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay with no coinsurance, and telehealth benefits range from no copay to a $40 copay with no coinsurance. Podiatry is not covered, and although some chiropractic services are covered for a $15 copay and no coinsurance, routine and other chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and memory fitness, with no copays and no coinsurance. However, additional preventive benefits are only partially covered, excluding services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and home-based palliative care.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers routine hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $30 copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $399 to $999 and no coinsurance, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) partially covers vision services, featuring no copay, no coinsurance, and no deductible for covered services like one annual routine eye exam and a $300 yearly limit on contact lenses or eyeglasses (lenses and frames). Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
Dental services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), offering preventive and diagnostic care with no copay and no coinsurance up to a $1,000 annual limit. Medicare-covered dental requires a $30 copay and no coinsurance, while restorative services have a $25 copay and no coinsurance; however, fluoride treatments, maxillofacial prosthetics, implants, 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, though prior authorization is required. Medicare Part B drugs for these services, including chemotherapy and insulin, incur a 0% to 20% coinsurance, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required. Covered DME, prosthetics, medical supplies, and diabetic supplies require a 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts are covered with no copay.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required for these benefits. Lab services, outpatient X-rays, and diagnostic radiological services feature no copays, while diagnostic tests carry a $0 to $105 copay with no coinsurance, and therapeutic radiological services require a minimum $35 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers acupuncture with a $30 copay and no coinsurance for up to 20 treatments per year, requiring prior authorization. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though prior authorization is required for meals and some CMS OTC list drugs are excluded.
Get Personalized Help from a licensed insurance agent
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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