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Medicare Advantage · HMOPOS
Gold Kidney Health Plan
Plan year 2027

Gold Heart & Diabetes Plus (HMO-POS C-SNP) H1526-012

Monthly premium
$0
+ your Part B premium
Max out-of-pocket
$4,100
in-network annual cap
Primary care
$0
per visit copay
Specialist
$55
per visit
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as cardiovascular disorders, diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.
Extra benefits for members who qualify
  • $125/month food and produce allowance
  • General supports for living
These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.

Your costs at a glanceIn-network, for the 2027 plan year

Medical deductible
$0
Max out-of-pocket, out of network
$13,000
Rx deductible
$0
Inpatient hospital
Days 1-5: $220/day, Days 6-90: $0/day
Inpatient mental health
Days 1-5: $220/day, Days 6-90: $0/day
Outpatient surgery
$220
Emergency room
$120
Urgent care
$40

What's included, and what it's actually worth6 benefits included. Tap any card for the detail

Dental

$3,000/yr preventive dental allowance
Details$3,000/yr preventive dental allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Hearing

$195–$1,395copay per hearing aid
Details$195–$1,395 copay per hearing aid
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$55 copay
In-network$55 copay per visit
Inpatient Hospital$220/day, days 1–5
In-networkDays 1-5: $220/day, Days 6-90: $0/day
Outpatient Surgery$220 copay
In-network$220 copay per procedure
Mental HealthDays 1-5: $220/day, Days 6-90: $0/day
Inpatient psychiatricDays 1-5: $220/day, Days 6-90: $0/day
VisionRoutine vision benefit
DetailsRoutine vision benefit
This is a supplemental benefit with plan-specific limits. See plan documents for details.
Fitness$0 fitness benefit
Transportation24 one-way trips/year
Trips per year24 one-way trips/year
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Our take

Where this plan shines

This plan has a $0 monthly premium.
This plan’s out-of-pocket maximum is below the national median.
See your primary doctor for $0.
No separate drug deductible.
No separate medical deductible.

Things to know before you enroll

The specialist copay ($55) is on the higher side — worth comparing if you see specialists often.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Plan questions

Common questions about Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS)

What does Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) cover?

Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) is a Chronic Condition Special Needs Plan, a Medicare Advantage plan for people whose qualifying condition the plan verifies, including cardiovascular disorders and diabetes. The plan record also identifies Part D prescription drug coverage. Published supplemental benefits include dental ($3,000/yr preventive dental allowance), vision (Routine vision benefit), hearing ($195–$1,395 copay per hearing aid), and fitness ($0 fitness benefit). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) cost in 2027?

The published 2027 monthly plan premium for Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) is $0. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $0. The listed Part D deductible is $0. The in-network medical out-of-pocket maximum is $4,100; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $55. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS)?

CMS lists Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) as a HMOPOS plan. The record also identifies point-of-service flexibility, but exact out-of-network rules can vary. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

What chronic conditions qualify for Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS)?

Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) is listed in the current plan record as a C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as cardiovascular disorders, diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Learn about Special Needs Plans

How does Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) coordinate care for my chronic condition?

Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) is identified in the current plan record as a Chronic Condition Special Needs Plan for qualifying conditions that include cardiovascular disorders and diabetes. The record also lists dental ($3,000/yr preventive dental allowance), vision (Routine vision benefit), and hearing ($195–$1,395 copay per hearing aid). The data on this page does not describe a personal care plan or promise a specific care coordinator. Review the Evidence of Coverage and ask the plan how its model of care, provider communication, and medication support apply to your verified condition.

When can I enroll in Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS)?

Gold Heart & Diabetes Plus (HMO-POS C-SNP) (HMOPOS) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a C-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

More plan options

Browse the full 2027 Chronic Condition Special Needs Plan directory. This plan is offered in Florida. Plan availability can vary by county.

Helpful next steps

Gold Heart & Diabetes Plus H1526-012 (HMO-POS C-SNP) — 2027