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Oct 15th - Dec 7th
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Gold Heart & Diabetes Complete (HMO-POS C-SNP)

Health Insurance Company: Gold Kidney Health Plan

Medicare Advantage Plan Details

Chronic Condition (C-SNP)

Gold Kidney Health Plan
$20 /mo
monthly premium
Gold Heart & Diabetes Complete (HMO-POS C-SNP)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Dental
  • Vision
  • Hearing
(coming soon)

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$9350
Rx Drug Coverage
Yes
Rx Deductible
$590
Primary Doctor Office Visit
20% coinsurance per visit
Specialist Office Visit
20% coinsurance per visit

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
No
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Specialist Office Visit
In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0 copay

Emergency Room

20% coinsurance per visit (always covered)

Ambulance Coverage

In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Medicare-covered lab services: In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Medicare-covered x-ray services: In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: Coming soon
Out-of-network: Coming soon
Inpatient hospital psychiatric:
In-network: Coming soon
Out-of-network: Coming soon

Rehabilitation Coverage

Occupational therapy services:
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Physical therapy and speech and language therapy services:
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Urgent Care Coverage

20% coinsurance per visit (always covered)

Skilled Nursing Facility (SNF)

In-network: Coming soon
Out-of-network: Coming soon

Mental Health Coverage

Medicare-covered individual sessions: In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Medicare-covered group sessions: In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Dental, Vision, Hearing Benefits

Dental Services

Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay

Vision Benefits

Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: $0 copay
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses: In-network: $0 copay
Out-of-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Hearing aids:
Hearing aids (all types): In-network: $0 copay
Out-of-network: $0 copay

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
Yes
Acupuncture
Yes
Massage Therapy
Yes
Health Education
Yes
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
Yes
In-home support services
Yes
Home and bathroom safety devices
Yes
Meals for short duration
Yes

Plan Links

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Where This Plan is Available

Additional Plan Info

Plan Year:
2025
Insurance Company Website:
Gold Kidney Health Plan

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • 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Ⓡ
  • Wellcare
  • WellPoint