A non-government entity
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 Tulsa and Oklahoma City Metro. 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 $2.00. 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 $3900.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, members pay no copay at standard pharmacies or through preferred mail order. Tier 2 generic medications cost a $9 copay for a one-month supply at standard pharmacies, but you can receive a three-month supply for no copay via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with a reduced $94 copay for a three-month supply when using preferred mail order. Higher-tier medications require coinsurance instead of a flat copayment, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. These clear copay and coinsurance structures help members easily estimate their out-of-pocket prescription drug costs.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers robust medical coverage with affordable cost-sharing, featuring no copay and no coinsurance for primary care visits and preventive services. Specialist visits require a $25 copay, while inpatient hospital stays have a $250 daily copay for the first seven days with no coinsurance. Outpatient hospital services and emergency care are also covered with no coinsurance, requiring copays of up to $250 and $150 respectively. This plan also provides valuable dental, vision, and hearing benefits, including no copay or coinsurance for routine eye exams, routine hearing tests, and preventive dental services up to a $3,000 annual limit. Additionally, home health care and home infusion services have no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Prescription hearing aids, Medicare Part B drugs, and skilled nursing care are also covered with specific copays or coinsurance.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $250 daily copay for days 1 to 7 and no copay for days 8 through 90. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute days are covered with no copay.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $250 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 to $35 copay with no coinsurance.
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 for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan cover Medicare-approved ground and air ambulance services with a $335 copay per trip and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are 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, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care is available with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 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 and therapy services require a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatments have copays ranging from $30 to $35 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance for services like annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional preventive benefits are partially covered, offering a memory fitness benefit with no copay, while sub-services such as health education, weight management, in-home safety assessments, personal emergency response systems, and nutritional therapy are not covered.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing services with no deductible, including Medicare-covered exams for a $25 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. OTC hearing aids are covered with no copay and no coinsurance, while prescription hearing aids are partially covered with copays between $399 and $999 and no coinsurance, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Vision services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), offering no copay, no coinsurance, and no deductible for one annual routine eye exam and either one pair of eyeglasses or contact lenses per year up to a $250 limit. 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 $3,000 annual limit, with a $25 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services. Services that are not covered under this plan include fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
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—including chemotherapy, radiation, and other covered drugs—carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
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 coverage for these services.
Medical Equipment See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with a 20% coinsurance and no copay. Prior authorization is required for these benefits, 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 prior authorization, featuring no copay and no coinsurance for lab services and diagnostic radiological services. Diagnostic procedures and tests require a copay ranging from $0 to $65 with no coinsurance, outpatient X-rays require a coinsurance with no copay, and therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance, subject to prior authorization. While some services are covered, standard 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
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other Services under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) are partially covered, featuring acupuncture with a $25 copay and no coinsurance (limited to 20 treatments per year, prior authorization required) and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and other miscellaneous services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved