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Humana Gold Plus - End Stage Renal Disease (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus - End Stage Renal Disease (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 - End Stage Renal Disease (HMO C-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Detroit Metro Area. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Humana Gold Plus - End Stage Renal Disease (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 - End Stage Renal Disease (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 - End Stage Renal Disease (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 - End Stage Renal Disease (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 $590.00 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 $7500.00 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 - End Stage Renal Disease (HMO C-SNP)
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Drug Coverage
The Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the following amounts for your medications, depending on the drug tier and pharmacy type. For preferred generic drugs, you will pay no copay at standard and preferred mail pharmacies. For standard generic drugs, the copay is $47.00. For preferred brand drugs, the coinsurance is 46%, and for non-preferred drugs, the coinsurance is 25%. For specialty tier drugs, there is no copay at standard pharmacies, and a $11.00 copay at standard mail pharmacies.
Additional Benefits
The Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan offers coverage for a wide range of services, with a focus on kidney care. Inpatient hospital stays have a copay, depending on the length of stay, while outpatient services, including primary care and specialist visits, often have no copay. The plan also includes coverage for ambulance services, emergency services, and a variety of therapies, with varying copays and coinsurance amounts. Additional benefits of the plan include coverage for preventive services, hearing, vision, and dental services, with no copays for many services. The plan also covers dialysis, home health services, and home infusion, with no copays in many cases. Other benefits include acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric inpatient hospital stays. For acute stays, you will pay a $435 copay for days 1-5, and no copay for days 6-90; for days 91-999, there is no copay. For psychiatric stays, you will pay a $435 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $435, Observation Services with a $435 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a copay between $0 and $100 for both individual and group sessions. Outpatient Blood Services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan, with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $315 copay, and transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan covers primary care physician services, with no copay, and physician specialist services, with no copay. Chiropractic services have a $15 copay, and occupational therapy services have a copay between $10 and $35. Physical therapy and speech-language pathology services have a copay between $10 and $35. Additional telehealth benefits have a copay between $0 and $45.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and other preventive services. Annual physical exams have no copay, while other services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams and routine hearing exams have no copay, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids have a copay between $399 and $999, and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams, and contact lenses and eyeglasses (lenses and frames) are covered with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered under this plan, with a $1,500 maximum benefit per year. You will have no copay for Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (fixed), and Oral and Maxillofacial Surgery. Fluoride Treatment, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. You will pay a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% for all covered drugs.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan. There is no copay for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance with no copay. Some services are covered, but Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $105, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $525, Therapeutic Radiological Services have a coinsurance up to 20% and no copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus - End Stage Renal Disease (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 not covered by the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) 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
The Humana Gold Plus - End Stage Renal Disease (HMO C-SNP) plan covers acupuncture with no copay, and a limit of 20 treatments per year. Over-the-counter items are covered with a maximum benefit of $1500 per year, and a meal benefit is also covered with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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