Humana Gold Plus - Diabetes and Heart (C-SNP): Costs+Coverage H0028-039-0
Humana Gold Plus - Diabetes and Heart (C-SNP): Costs+Coverage H0028-039-0
Explore the benefits and costs of Humana Gold Plus - Diabetes and Heart (C-SNP HMO), a 2025 Medicare Special Needs Plan designed to meet your unique healthcare needs. This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by Humana are different than Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Plan ID H0028-039-0 Overview | |
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Health Plan ID: | H0028-039-0 |
Medicare Advantage Plan Type: | HMO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced $0.00 deductible |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | See List |
Insured By: | Humana |
We're Here to Help You Enroll |
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Health Plan Cost Sharing & Benefits
Humana Gold Plus - Diabetes and Heart is a Health Maintenance Organization (HMO) plan. As an HMO C-SNP member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Humana Gold Plus - Diabetes and Heart does cover out-of-network care for emergencies and out-of-area dialysis.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $15 Copay Prior Authorization Required, Referral Required |
Wellness & Preventive Programs: | |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $15 Copay Prior Authorization Required, Referral Required |
Routine Foot Care: | $0 |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $20 Copay Prior Authorization Required, Referral Required |
Routine chiropractic: | $20 Copay Prior Authorization Required, Referral Required |
Emergency and Urgent Care | |
Emergency room care: | $135 Copay |
Urgent care: | $65 Copay |
Ground ambulance: | $300 Copay |
Inpatient hospital care: | $75.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital care: | $30 Copay Prior Authorization Required, Referral Required |
Skilled Nursing Facility: | $20.00 per day for days 1 through 20 $203.00 per day for days 21 through 50 $203.00 per day for days 51 and beyond |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $25 Copay |
Outpatient group therapy: | $25 Copay |
Inpatient psychiatric hospital care: | $75.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy: | $25 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $25 Copay Prior Authorization Required, Referral Required |
Occupational therapy: | $25 Copay Prior Authorization Required, Referral Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment: | 16% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $100 Copay Prior Authorization Required, Referral Required |
Lab services: | $65 Copay Prior Authorization Required, Referral Required |
Outpatient x-rays: | $65 Copay Prior Authorization Required, Referral Required |
Diagnostic tests and procedures: | $65 Copay Prior Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Supplemental Health Plan Benefits (H0028-039-0)
The following is a summary of the supplemental benefits Humana includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | Maximum dental benefit: | $2,500.00 Every year |
Oral exam (In-Network) | Covered |
Fluoride treatment (In-Network) | Covered |
Dental x-ray(s) (In-Network) | Covered |
Cleaning (In-Network) | Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Covered |
Non-routine services (In-Network) | Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing | |
Fitting/evaluation (In-Network) | $0 Copay Prior Authorization Required, Referral Required, Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Prior Authorization Required, Referral Required |
Vision | Maximum vision benefit: | $200.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay Prior Authorization Required, Referral Required |
Contact lenses (In-Network) | $0 Copay |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Humana Gold Plus - Diabetes and Heart includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $0.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before Humana begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Humana Gold Plus - Diabetes and Heart has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $0.00 copay |
2 (Generic) | N/A | $0.00 copay |
3 (Preferred Brand) | N/A | $45.00 copay |
4 (Non-Preferred Drug) | N/A | $99.00 copay |
5 (Specialty Tier) | N/A | 33% |
5-Star Rating Marks
p>Each year, Medicare Advantage C-SNPs are rated by the Centers for Medicare & Medicaid Services (CMS) across nine categories using a 5-star system. These star ratings are designed to help you assess the quality of care and service offered by this Humana plan.CMS Measure | Star Rating |
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2025 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Eligibility Criteria for Enrolling in Humana Gold Plus - Diabetes and Heart
To enroll in Humana Gold Plus - Diabetes and Heart, you must meet the following criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabling chronic condition (disease) is one that persists for one year or longer, requiring ongoing medical care and/or limiting daily activities. These conditions include:
- Autoimmune disorders
- End-stage renal disease
- Cancer
- Cardiovascular disorders
- Blood disorders (Hematologic disorders)
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Stroke
- Mental health conditions
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes.
Important Enrollment Periods
Once you’ve confirmed your eligibility for Humana Gold Plus - Diabetes and Heart, it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:
- Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
- Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
- Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.
For comprehensive information on these enrollment periods, learn more here and make well-informed Medicare decisions.
Plan Availability
Humana Gold Plus - Diabetes and Heart (H0028-039-0) is available in the following locations (click to open):
Contact Humana
Call 1-877-388-0596 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Sun 8am-11pm EST) and learn more about this Special Needs Plan and other plans on this site.
You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
Plan Website: | http://www.humana.com/medicare |
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Formulay Information: | https://www.humana.com/pharmacy/ |
Pharmacy Information: | Humana Pharmacy Page |
Prospective Members: | (800)833-2364 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered are by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.