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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 New Jersey. 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 $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 $8850.00 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 $450. You can minimize your out-of-pocket prescription expenses with no copay for Tier 1 preferred generics and Tier 6 select care drugs filled at standard pharmacies or through preferred mail order. Tier 2 generic medications are also highly affordable, costing as little as a $5 copay for a one-month supply, or no copay for a three-month supply when using preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs have a $47 copay for a one-month supply across standard pharmacies and mail-order options. Higher-tier prescriptions require coinsurance rather than flat copays, with Tier 4 non-preferred drugs costing 50 percent coinsurance and Tier 5 specialty drugs requiring a 27 percent coinsurance.
Additional Benefits
The Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan offers comprehensive healthcare coverage with no copay for primary care visits, preventive screenings, routine dental care, and home health services. For specialized care, members pay predictable copays, such as $15 for specialist visits and a $355 daily copay for the first seven days of an acute inpatient hospital stay, after which there is no copay. Emergency room visits carry a $115 copay, which is waived if admitted within 24 hours, while urgent care services require a $40 copay. Additional benefits include up to 24 one-way trips to plan-approved locations and routine vision care with a $450 annual allowance for eyewear, all with no copay. Routine hearing exams and over-the-counter items are also covered with no copay, while prescription hearing aids require copays ranging from $299 to $899. Durable medical equipment, diabetic supplies, and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring prior authorization and referrals. Acute stays require a $355 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $260 daily copay for days 1-7 and no copay for days 8-90. Upgrades, non-Medicare-covered stays, and psychiatric stays past 90 days are not covered.
Outpatient Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $450, observation services have a $355 copay per stay, and outpatient substance abuse sessions carry a $20 to $35 copay, with prior authorization or referrals required for most care.
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 these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance per service. The plan also provides up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under the Humana Gold Plus - Diabetes and Heart (HMO C-SNP) plan 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 with no coinsurance, while worldwide emergency, urgent care, and emergency transportation are all 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, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, speech, and mental health therapies require a $20 copay with no coinsurance, while telehealth ranges from no copay to a $40 copay with no coinsurance, and 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 annual physicals, kidney disease education, and other screenings. Additional preventive services are partially covered with no coinsurance, offering a memory fitness benefit with no copay, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers hearing services with no coinsurance, including Medicare-covered exams for a $15 copay, and routine exams, fitting evaluations, and OTC hearing aids with no copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $299 to $899 for up to two devices per year, 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) offers partially covered vision services with no coinsurance and copays ranging from $0 to $15, with prior authorization and referrals required. Covered benefits include one annual routine eye exam and up to $450 yearly for contact lenses or eyeglasses with no copay, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) dental services are partially covered, featuring no copay or coinsurance for preventive care up to a $2,000 annual limit, a $15 copay and no coinsurance for Medicare-covered dental, and a $25 copay and no coinsurance for restorative and periodontic services. Fluoride treatment, endodontics, prosthodontics, maxillofacial prosthetics, implants, oral surgery, 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, requiring prior authorization and step therapy. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs carry a $35 copay and no coinsurance 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 and a referral are required to access 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. Diabetic therapeutic shoes and inserts are covered with a $10 copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers diagnostic and radiological services, offering no copay for lab services and outpatient X-rays, and no coinsurance for diagnostic services. Diagnostic procedures and tests carry a copay of $0 to $50, diagnostic radiological services have a $0 minimum copay, and therapeutic radiological services require a minimum 20% coinsurance, with prior authorization and referrals required.
Home Health Services See details
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered 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, but some services are covered while standard 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, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and while a prior three-day hospital stay is not required, additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus - Diabetes and Heart (HMO C-SNP), as Dual Eligible SNPs with Highly Integrated Services and other unspecified services are not covered. Covered benefits include acupuncture for a $20 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance.
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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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