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Written by David Bynon [3], Medicare Analyst since 2012.  Last updated July 16, 2025

MedicareWire is a public-trust resource. We do not sell plans or accept payment to influence content. Here's why you can trust our data and how we operate. Also see our references and how we're building EEAT trust.

Special Needs Plans
 » 
Arizona
 » 
Pima County
 » 
Gold Circle Dialysis

Gold Circle Dialysis (C-SNP) Plan Details for Pima County, AZ

Plan Basics | Costs | Drug Coverage | Star Rating | Contact

This page provides coverage and cost details for Gold Kidney Health Plan’s H4869-012-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.

Gold Kidney Health Plan logo, a registered trademark of Gold Kidney Health Plan
CMS 2025 Rating: ☆☆☆☆☆*

*This plan is new and has not yet been rated by CMS.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Gold Kidney Health Plan logo is a registered trademark.[2] Its use by MedicareWire is strictly for editorial purposes. This is not a solicitation of insurance.

This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.

Individuals must meet all Chronic or Disabling Condition SNP qualification requirements to join this C-SNP plan.

Gold Circle Dialysis Basic Plan Details

Plan ID
H4869-012-0
Plan Type
HMO-POS C-SNP
Plan Year
2025
Premium
$0.00/mo
Plus your Medicare Part B premium.
Health Plan Deductible
$0.00
Out-of-Pocket Maximum
9,350.00 /yr (in-network)
Part B Reduction
$0.00/mo
Drug Plan Benefit
Basic
$590.00 deductible
Supplemental Benefits
None
Availability
Pima County, AZ
Insured By
Gold Kidney Health Plan

Health Plan Out-of-Pocket Costs

The following table is a summary of the most common out-of-pocket costs you will incur if you join this Gold Kidney Health Plan plan:

Doctor's Office Visits

Primary
20% Coinsurance
Specialist
20% Coinsurance

Emergency, Urgent, and Inpatient Hospital Coverage

Emergency room care
20% Coinsurance
Urgent care
20% Coinsurance
Ground ambulance
20% Coinsurance
Inpatient hospital care
Coming Soon
Skilled Nursing Facility
Unknown

Foot Care

Foot Exams and Treatments (Medicare-covered)
20% Coinsurance
Routine Foot Care
Not Covered

Chiropractic Care

Medicare-covered chiropractic
20% Coinsurance
Routine chiropractic
Not Covered

Mental Health Services

Outpatient individual therapy
20% Coinsurance
Outpatient group therapy
20% Coinsurance
Inpatient psychiatric hospital care
Coming Soon

Rehabilitation Services

Physical therapy and speech and language therapy
20% Coinsurance
Occupational therapy
20% Coinsurance

Medical Equipment and Supplies

Diabetes supplies
20% Coinsurance
Durable medical equipment
20% Coinsurance
Prior Authorization Required
Prosthetics
20% Coinsurance

Diagnostics, Lab Services, and Imaging

Diagnostic radiology services
20% Coinsurance
Lab services
20% Coinsurance
Outpatient x-rays
20% Coinsurance
Diagnostic tests and procedures
20% Coinsurance

Medicare Part B Drugs

Chemotherapy
20% Coinsurance
Other Part B drugs (Medicare-covered)
20% Coinsurance

Dental Services

Medicare Covered Preventive Dental
20% Coinsurance
Oral exam
Not Covered
Dental x-rays
Not Covered
Cleaning
Not Covered
Periodontics
Not Covered
Endodontics
Not Covered
Restorative Services
Not Covered

Hearing Aids and Services

Fitting/evaluation
Not Covered
Hearing aids
Not Covered
Hearing exam
Not Covered

Vision Services

Medicare-covered eye exam
20% Coinsurance
Routine eye exam
Not Covered
Eyewear benefits
None

Prescription Drug Costs & Benefits

Gold Circle Dialysis includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.

Prescription Drug Premium with Extra Help

Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.

Premium Subsidy Details with Extra Help
Low Income Premium Subsidy: ${part_d_lips_amount}
Low Income Premium Subsidy CMS Pays: $0.00
Low Income Subsidy Premium: $0.00

If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.

Prescription Drug Deductible

The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Gold Kidney Health Plan begins paying its share.

Prescription Drug Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Gold Circle Dialysis has out-of-pocket costs you must pay when you pick up your prescriptions.

Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Cost data not available.
*The Part D deductible does not apply.

CMS Rating Marks

Each year Medicare rates C-SNP plans, using a 5-star rating system, in nine major categories. These ratings are designed to help you understand the quality of care and service you can expect if you qualify and choose to join Gold Circle Dialysis.

CMS Star Ratings for Plan Performance Measures
CMS Measure Star Rating
2025 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines {hd1}
Managing Chronic (Long Term) Conditions {hd2}
Member Experience with Health Plan {hd3}
Complaints and Changes in Plans Performance {hd4}
Health Plan Customer Service {hd5}
Drug Plan Customer Service {dd1}
Complaints and Changes in the Drug Plan {dd2}
Member Experience with the Drug Plan {dd3}
Drug Safety and Accuracy of Drug Pricing {dd4}

How to Qualify to Enroll in
Gold Circle Dialysis

To be eligible to enroll in Gold Circle Dialysis, you must meet these requirements:

  1. You are eligible for Medicare;
  2. You live in Pima County (the plan’s service area); and
  3. You have been diagnosed with one or more severe or disabling chronic conditions.

A disabling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:

  • Autoimmune disorders
  • End-stage renal disease
  • Cancer
  • Cardiovascular disorders
  • Hematologic disorders
  • HIV/AIDS
  • Chronic heart failure
  • Chronic lung disorders
  • Neurologic disorders
  • Dementia
  • Diabetes
  • End-stage liver disease
  • Neurologic disorders
  • Stroke
  • Mental health conditions

Additional C-SNP Plan Options

Here are some additional Medicare SNP plans that might be worth reviewing:

  1. Gold Heart & Diabetes
  2. Gold Circle Dialysis
  3. Gold Dialysis
  4. Gold Heart & Diabetes Complete
  5. Gold Heart & Diabetes

Contact Us About Gold Kidney Health Plan

Helpful Links and Contact Information for Gold Kidney Health Plan
Website: Gold Kidney Health Plan Plan Page (opens in new tab)
Providers: Gold Kidney Health Plan Providers Page (opens in new tab)
Formulary: Gold Kidney Health Plan Formulary Page (opens in new tab)
Pharmacy: Gold Kidney Health Plan Pharmacy Page (opens in new tab)
New Member Health Plan Help: (888)376-6188
New Member Health Plan TTY: 711
New Member Part D Help: (888)376-6188
New Member Part D 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.

Health Plan Compatibility

Medicare Advantage Special Needs Plans (SNPs) are generally incompatible with most other health insurance options. Enrolling in an SNP plan while having Medicare Part A and/or Medicare Part B will result in disenrollment from Original Medicare. Additionally, it is not possible to simultaneously hold a Medicare Supplement Insurance policy and be part of an SNP plan.

With a D-SNP, members keep the same Medicaid plan and Medicaid benefits. If you are a Veteran and have VA Health Benefits, you may be able to care from your local VA hospital.

Citations & References

  • Gold Kidney Health Plan, http://goldkidney.com, Last Accessed October 13, 2024
  • Medicaid.gov, "Medicaid & CHIP in Arizona", Last Accessed October 1, 2024
  • CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
  • CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
  • CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024

Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.

For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.

Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.

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On This Page

  • Introduction
  • Plan Basics
  • Download Summary of Benefits
  • Out-of-Pocket Costs
  • Supplemental Benefits
  • Prescription Benefits
  • Plan Rating Marks
  • Get Help

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[3]About the Author

David Bynon is a Medicare analyst, published author, and U.S. Navy veteran with over 40 years of experience in cryptology, cybersecurity, and healthcare systems. Since founding MedicareWire in 2012, he has delivered independent, data-driven Medicare research to help seniors make informed, confident decisions.

David is also the founder of TrustPublishing.com and the inventor of the Memory-First Publishing and Semantic Digest protocols.

Connect with David on LinkedIn or view his Amazon Author Profile. His latest book, Why Medicare Advantage Plans Are Bad, is available on Amazon.

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