2027 Medicare Advantage plan

Humana Gold Plus – Diabetes and Heart (HMO C-SNP): 2027 benefits and costs

Humana HMO C-SNP Special Needs Plan

CMS plan ID: H1036-336-0 · Plan year: 2027

Humana Gold Plus – Diabetes and Heart (HMO C-SNP) is a 2027 Medicare Advantage plan offered by Humana. It is listed in Florida.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$700.00

In-network medical out-of-pocket maximum$3,300.00

Organization: Humana
Plan organization: HUMANA MEDICAL PLAN, INC.
Parent company: Humana Inc.
Plan type: HMO C-SNP
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
Special Needs Plan type: Chronic or Disabling Condition
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)
Monthly Part B premium after plan reduction: $102.50 (estimated)$209.50 standard premium less $107.00 plan reduction.

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $3,300.00
Applies to certain in-network supplemental services.

Part B premium reduction: $107.00

Who can join this Special Needs Plan?

This plan is for people with qualifying chronic or disabling conditions. The plan must confirm that your condition meets its eligibility rules.

Plan eligibility type: Chronic or Disabling Condition
Qualifying conditions: Diabetes Mellitus, Chronic Heart Failure, and Cardiovascular Disorders

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0.00 copay Service-specific deductible No
Specialist visit	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Telehealth	$0.00 to $20.00 copay Service-specific deductible No	Approval required No Referral required No
Emergency care	$150.00 copay
Urgent care	$15.00 copay
Home health	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Dialysis	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Medicare-covered foot care	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Other health professionals	$0.00 to $20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–6: $250.00 copay per day Days 7–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–6: $250.00 copay per day Days 7–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $160.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$0.00 to $200.00 copay Service-specific deductible No
Hospital observation services	$250.00 copay Service-specific deductible No
Ambulatory surgical center	$0.00 to $100.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Outpatient blood	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$0.00 to $200.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Laboratory services	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Diagnostic radiology (CT, MRI)	$0.00 to $250.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Therapeutic radiology	$20.00 to $50.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
X-rays	$0.00 to $125.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$35.00 copay Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	$35.00 copay Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, individual sessions	$20.00 to $35.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Substance use treatment, group sessions	$20.00 to $35.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Opioid treatment program	$20.00 to $35.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, individual sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, group sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, individual sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, group sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$25.00 to $40.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	$25.00 to $40.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$10.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Intensive cardiac rehabilitation	$10.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Pulmonary rehabilitation	$10.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Supervised exercise for peripheral artery disease	$10.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$0.00 to $260.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	$0.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	$0.00 copay Service-specific deductible No	Approval required Yes
Diabetic supplies	$0.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	$0.00 copay Service-specific deductible No	Approval required Yes
Diabetic monitors	$0.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$20.00 copay
Oral examsAdditional plan benefit	$0.00 copay
Dental X-raysAdditional plan benefit	$0.00 copay
Dental cleaningAdditional plan benefit	$0.00 copay
Restorative dental careAdditional plan benefit	$0.00 copay
Gum treatment (periodontics)Additional plan benefit	$0.00 copay
Removable dentures (prosthodontics)Additional plan benefit	$0.00 copay
Oral surgeryAdditional plan benefit	$0.00 copay
Other dental servicesAdditional plan benefit	$0.00 copay

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0.00 to $20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Routine eye examsAdditional plan benefit	$0.00 copay	Approval required Yes Referral required Yes
Medicare-covered eyewear	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Contact lensesAdditional plan benefit	$0.00 copay	Approval required Yes Referral required Yes
Eyeglasses, lenses and framesAdditional plan benefit	$0.00 copay	Approval required Yes Referral required Yes

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Routine hearing examsAdditional plan benefit	$0.00 copay	Approval required Yes Referral required Yes
Hearing aid fitting and evaluationAdditional plan benefit	$0.00 copay	Approval required Yes Referral required Yes
Prescription hearing aids (all types)Additional plan benefit	$199.00 to $475.00 copay Service-specific deductible No	Approval required No Referral required No
Over-the-counter hearing aidsAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Supplemental acupunctureAdditional plan benefit	$5.00 copay Service-specific deductible No	Approval required Yes Referral required No
Over-the-counter health itemsAdditional plan benefit	$0.00 copay Service-specific deductible No
Limited-duration mealsAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No

Allowances and optional benefits

Healthy Options/OTC Allowance

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Over-the-counter health items; Over-the-counter hearing aids; Additional Benefits for SSBCI
Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s): Food and produce (SSBCI: Chronic Care Assistance and Healthy Options); Pest control (SSBCI: Chronic Care Assistance and Healthy Options); Transportation for non-medical needs (SSBCI: Chronic Care Assistance and Healthy Options); Indoor Air Quality Equipment and Services (SSBCI: Chronic Care Assistance and Healthy Options); Social support benefit (SSBCI: Chronic Care Assistance and Healthy Options); Support for daily living (SSBCI: Chronic Care Assistance and Healthy Options); Home and Bathroom Safety Devices and Modifications (SSBCI: Chronic Care Assistance and Healthy Options); Personal emergency alert system (SSBCI: Chronic Care Assistance and Healthy Options)
How benefits are provided: Debit Card
Advance choice of benefits required: No
Shared benefit limit: $300.00
How often this limit applies: Every year
Are the benefits combined such that a single benefit maximum available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?: Yes
Shared limit on visits or trips: No
Are the benefits combined such that a single visit or trip limit available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?: No

Benefits for qualifying members

Chronic Condition Care Assistance

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation
To qualify: Participation in a Care Management Program
Covered package services cost $0 until the package limit is reached: Yes
Package limit: $500.00
How benefits are provided: Other
How to use the benefit: Purchases must be coordinated by a care manager on the member's behalf.

Full package terms are not summarized here.

Chronic Care Assistance and Healthy Options

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Conditions associated with cognitive impairment; Conditions with functional challenges; Other 1; Other 2
Qualifying conditions: Chronic Hyperlipidemia
Qualifying conditions: Chronic Hypertension
To qualify: Participation in a Care Management Program
Included services: Transportation to plan-approved health locations; Over-the-counter health items; Food and produce; Additional meal benefits; Pest control; Transportation for non-medical needs; Indoor Air Quality Equipment and Services; Social support benefit; Support for daily living; Home and Bathroom Safety Devices and Modifications; In-Home Safety Assessment; Personal emergency alert system; Wigs for chemotherapy-related hair loss; Adult Day Health Services; In-Home Support Services; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; Prescription Hearing Aids (all types); Over-the-counter hearing aids
Some package benefits are exempt from the deductible: No
Package limit: $500.00
How often this limit applies: Every year
How benefits are provided: Other; Debit Card
How to use the benefit: Purchases must be coordinated by a care manager on the member's behalf.
Services sharing the package limit: Transportation to plan-approved health locations; Over-the-counter health items; Food and produce; Additional meal benefits; Pest control; Transportation for non-medical needs; Indoor Air Quality Equipment and Services; Social support benefit; Support for daily living; Home and Bathroom Safety Devices and Modifications; In-Home Safety Assessment; Personal emergency alert system; Wigs for chemotherapy-related hair loss; Adult Day Health Services; In-Home Support Services; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; Prescription Hearing Aids (all types); Over-the-counter hearing aids

Full package terms are not summarized here.

Virtual Cardiac Recovery Program

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Congestive Heart Failure (CHF); Hypertension; Other 1; Other 2
Qualifying conditions: Pneumonia
Qualifying conditions: Respiratory Illnesses
All listed conditions required: No
Combination of conditions required: No
Included services: Other 1
Some package benefits are exempt from the deductible: No

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2; Tier 3; Tier 6 are exempt from the deductible.

Standard retail costs

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$0.00	$0.00
Tier 2Generic	$0.00	$0.00
Tier 3Preferred Brand	17%	17%
Tier 4Non-Preferred Drug	50%	50%
Tier 5Specialty Tier	25%	Not listed
Tier 6Select Care Drugs	$0.00	$0.00

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

Preferred mail order: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$0.00	$0.00
Tier 2Generic	$0.00	$0.00
Tier 3Preferred Brand	17%	15%
Tier 4Non-Preferred Drug	50%	50%
Tier 5Specialty Tier	25%	Not listed
Tier 6Select Care Drugs	$0.00	$0.00

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$10.00	$30.00
Tier 2Generic	$20.00	$60.00
Tier 3Preferred Brand	17%	17%
Tier 4Non-Preferred Drug	50%	50%
Tier 5Specialty Tier	25%	Not listed
Tier 6Select Care Drugs	$0.00	$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	17%
Tier 4Non-Preferred Drug	50%
Tier 5Specialty Tier	25%
Tier 6Select Care Drugs	$0.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	17%
Tier 4Non-Preferred Drug	50%
Tier 5Specialty Tier	25%
Tier 6Select Care Drugs	$0.00

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Both Part D and Excluded Drugs
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Tier 6: Select Care Drugs

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.