Gold Heart & Diabetes (HMO-POS C-SNP)
Florida Chronic Condition Special Needs C-SNP Plan (2026 Plan)
by Gold Kidney Health Plan
Additional Coverage
HearingVisionDental
Overall Government Star Rating
(coming soon)
Plan Name
Gold Heart & Diabetes (HMO-POS C-SNP)
Plan Type
Chronic Condition Special Needs Plan (C-SNP)
Gold Heart & Diabetes (HMO-POS C-SNP) is a Chronic Condition Special Needs Plan (C-SNP), which is available in Florida and offered by the health insurance company Gold Kidney Health Plan. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$0-$20 copay
Gold Heart & Diabetes (HMO-POS C-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $2,700 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Gold Heart & Diabetes (HMO-POS C-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
Gold Heart & Diabetes (HMO-POS C-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Gold Heart & Diabetes (HMO-POS C-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Gold Heart & Diabetes (HMO-POS C-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $0-$20 copay
Out-of-network: $20 copay
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0-$30 copay
Out-of-network: $30 copay
Lab services
In-network: $0-$30 copay
Out-of-network: $30 copay
Diagnostic radiology services (like MRI)
In-network: $0-$200 copay
Out-of-network: $200 copay
Outpatient x-rays
In-network: $0 copay
Out-of-network: $0 copay
Hospital Services
Inpatient hospital coverage
In-network:
Tier 1
$220 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
$220 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Outpatient hospital coverage
In-network: $0-$220 copay
Out-of-network: $220 copay
Skilled nursing facility
Skilled nursing facility
In-network:
Tier 1
$0 per day for days 1-20
$214 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$214 per day for days 21-100
$0 per stay
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $225 copay
Out-of-network: $225 copay
Therapy services
Occupational therapy visit
In-network: $10 copay
Out-of-network: $10 copay
Physical therapy & speech & language therapy visit
In-network: $10 copay
Out-of-network: $10 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $10 copay
Out-of-network: $10 copay
Outpatient individual therapy with a psychiatrist
In-network: $25 copay
Out-of-network: $25 copay
Outpatient group therapy visit
In-network: $10 copay
Out-of-network: $10 copay
Outpatient individual therapy visit
In-network: $25 copay
Out-of-network: $25 copay
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Diabetes supplies
In-network: $0 copay
Out-of-network: $0 copay
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Catastrophic coverage phase |
|---|
| Preferred Generic | $0.00 copay | $0 copay |
| Generic | $0.00 copay | $0 copay |
| Preferred Brand | $40.00 copay | $0 copay |
| Non-Preferred Drug | | |
| Specialty Tier | 33% coinsurance | $0 copay |
Part B Drugs
Chemotherapy drugs
In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Hearing
Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription
In-network: $195-$1395 copay
Out-of-network: $195-$1395 copay
Hearing aids - over the counter
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Endodontics
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Periodontics
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthodontics, removable
Maxillofacial prosthetics
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
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