Humana Gold Plus - Diabetes and Heart (C-SNP) Plan Details for Cabarrus County, NC
CMS rated this Humana plan (H1036-308-0) 5.0 stars (Excellent), making it a top-rated plan from this insurance company.
Humana Gold Plus - Diabetes and Heart (C-SNP HMO) is a Special Needs Plan (SNP). 2025 plan enrollment begins Oct 15. Get notified.
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 qualification requirements for eligibility to join this HMO C-SNP plan.
2025 Humana Gold Plus - Diabetes and Heart Cost and Coverage Notification
The 2025 cost and coverage information for Humana Gold Plus - Diabetes and Heart will not be available until early October. We'll notify you when it is available from CMS.
Sign-Up for 2025 Medicare Plan Notification. The 2025 enrollment period begins October 15.
Plan Basics | |
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Plan ID: | H1036-308-0 |
Plan Type: | HMO |
Plan Year: | 2024 |
Premium: | $0.00/mo Plus your Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced $145.00 deductible |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | Cabarrus County, NC |
Insured By: | Humana |
Summary of Benefits |
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Health Plan Cost Sharing & Benefits
Humana Gold Plus - Diabetes and Heart is a Health Maintenance Organization (HMO) plan. HMO C-SNP plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Humana Gold Plus - Diabetes and Heart does allow out-of-network care for emergencies and out-of-area dialysis.
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Humana plan:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $40 Copay Prior Authorization Required |
Wellness programs (e.g., fitness, nursing hotline): | |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $40 Copay Prior Authorization Required |
Routine foot care: | $40 Copay Prior Authorization Required |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $15 Copay Prior Authorization Required |
Routine chiropractic care: | $15 Copay Prior Authorization Required |
Emergency Care / Urgent Care | |
Emergency room care: | $100 Copay |
Urgent care: | $50 Copay |
Ground ambulance: | $300 Copay |
Inpatient hospital coverage: | $335.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient hospital coverage: | $365 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 and beyond |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $45 Copay |
Outpatient group therapy visit with a psychiatrist: | $45 Copay |
Inpatient hospital - psychiatric: | $587.00 per day for days 1 through 3 $0.00 per day for days 4 and beyond |
Outpatient group therapy visit: | $45 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $25 Copay Prior Authorization Required |
Occupational therapy visit: | $25 Copay Prior Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $300 Copay Prior Authorization Required |
Lab services: | $50 Copay Prior Authorization Required |
Outpatient x-rays: | $125 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $120 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Humana Gold Plus - Diabetes and Heart Summary of Benefits information.
Supplemental Health Plan Benefits (H1036-308-0)
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: | $1,000.00 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, Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Prior Authorization Required |
Vision | Maximum vision benefit: | $250.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | $0 Copay Prior Authorization Required |
Contact lenses (In-Network) | Covered Limits may apply |
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 details of this plan's prescription drug plan premium.
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 |
The Social Security Extra Help page has more information about the low-income subsidy (LIS) and how to enroll in the program.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $145.00. This is the amount you must pay at the pharmacy before Humana begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
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 (deductible does not apply) |
2 (Generic) | N/A | $0.00 copay |
3 (Preferred Brand) | N/A | $47.00 copay |
4 (Non-Preferred Drug) | N/A | $100.00 copay |
5 (Specialty Tier) | N/A | 31% |
6 (Select Care Drugs) | N/A | $0.00 copay |
5-Star 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 Humana Gold Plus - Diabetes and Heart.
CMS Measure | Star Rating |
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2024 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 |
How to Qualify to Enroll in
Humana Gold Plus - Diabetes and Heart
To be eligible to enroll in Humana Gold Plus - Diabetes and Heart, you must meet these requirements:
- You are eligible for Medicare;
- You live in Cabarrus County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabiling 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
This plan is for individuals with cardiovascular disorders and/or diabetes.
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- None.
Contact Humana
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.
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
- Humana, http://www.humana.com/medicare, Last Accessed October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in North Carolina", Last Accessed January 4, 2024
- CMS.gov, "Chronic Condition Special Needs Plans (C-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed January 3, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.