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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 Clark and Nye Counties. 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. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 $615.00 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 $950.00 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 $615. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, there is no copay for one-month and three-month supplies at standard pharmacies and through preferred mail order. Standard mail order options for Tier 1 and Tier 2 drugs incur a copay, starting at $10 and $20 respectively for a one-month supply. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, though you can save on three-month supplies with a $94 copay through preferred mail order. Higher-tier medications are subject to coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring a 47% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers robust medical coverage featuring no copay and no coinsurance for inpatient hospital stays, primary care visits, specialist consultations, and preventive care. Outpatient services, diagnostic lab tests, and home health care also require no copay, while emergency room visits incur a $150 copay and urgent care visits require a $65 copay. This plan also includes valuable supplemental benefits, offering routine dental, vision, and hearing exams with no copay, alongside up to $350 for eyewear and up to $1,750 for annual dental care. Additionally, members can access up to 36 one-way transportation trips and over-the-counter benefits with no copay, though dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization and referrals are required. While unlimited additional days are covered for acute care, upgrades, non-Medicare-covered stays, 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, including ambulatory surgical center, observation, and blood services which feature no copays. Outpatient hospital and substance abuse services are also covered with no coinsurance and copays ranging from $0 to $30, though some services require prior authorization and referrals.
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 these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ground ambulance services with a $335 copay and air ambulance services with a $630 copay, with no coinsurance required for either. Transportation services are partially covered, providing up to 36 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $65 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered under this plan with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers primary care, specialist, therapy, mental health, and podiatry services with no copay and no coinsurance, though chiropractic services are not covered. Telehealth services require a copay of $0 to $65, and opioid treatment program services have a copay of $0 to $30, both with no coinsurance.
Preventive Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) offers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and a memory fitness benefit. However, additional preventive benefits are only partially covered, with services such as health education, weight management programs, and in-home safety assessments not covered.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing exams and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two devices per year, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers vision services with no copay and no coinsurance, including one routine eye exam and up to $350 yearly for contact lenses or eyeglasses (lenses and frames). This benefit is partially covered, as other eye exam services, separate eyeglass lenses, separate eyeglass 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) up to a $1,750 annual maximum, featuring no copays and no coinsurance for most diagnostic, preventive, and comprehensive treatments. Prosthodontics are covered with no copay and a 30% coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required. Related Medicare Part B chemotherapy, insulin, and other drugs require a coinsurance ranging from no coinsurance to 20%, with insulin limited to 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 and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan, with durable medical equipment, prosthetic devices, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes from specified manufacturers are covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with prior authorization and referral requirements. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic procedures with a copay ranging from $0 to $65. Radiological services include outpatient X-rays with no copay but applicable coinsurance, diagnostic radiology with copays starting at $0, and therapeutic radiology with a minimum 20% coinsurance and an applicable copay.
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. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization and referral requirements. Although some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, though a prior three-day hospital stay is not, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) provides additional services with no copay and no coinsurance, including up to 20 acupuncture treatments per year, over-the-counter (OTC) items, and home-delivered meals for chronic or qualifying medical conditions. Prior authorization is required for both acupuncture and meal benefits, and certain other miscellaneous services are not covered.
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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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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