Gold Circle Dialysis (HMO-POS C-SNP) Costs & Coverage, Navajo County, Arizona
Gold Circle Dialysis (HMO-POS C-SNP) Costs & Coverage, Navajo County, Arizona
Explore the benefits and costs of Gold Circle Dialysis (HMO-POS C-SNP), a 2025 Medicare Special Needs Plan designed to meet your unique healthcare needs. This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by Gold Kidney Health Plan are different than Original Medicare. This private health insurance option, available to qualified individuals in Navajo County, AZ, may include additional benefits that are not provided by Medicare Part A and Part B.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Gold Kidney Health Plan logo is a registered trademark.[2]
| Feature | Details |
|---|---|
| Health Plan ID: | H4869-012-0 |
| Medicare Advantage Plan Type: | HMO-POS C-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $9,350.00 |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Basic, $590.00 deductible |
| Supplemental Benefits: | None |
| Availability: | Navajo County, AZ |
| Insured By: | Gold Kidney Health Plan |
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Health Plan Cost Sharing & Benefits
Gold Circle Dialysis is an HMO-POS (Point-of-Service) plan. While HMO-POS plans share many features with traditional Health Maintenance Organization (HMO) plans, they offer greater flexibility by allowing members to access healthcare providers outside the network for certain services. Typically, a referral from your physician is required to go out of network. Additionally, there are separate deductibles for in-network and out-of-network services.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | 20% Coinsurance |
| Specialist: | 20% Coinsurance |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | 20% Coinsurance |
| Urgent care: | 20% Coinsurance |
| Ground ambulance: | 20% Coinsurance |
| Inpatient hospital care: | Coming Soon |
| Skilled Nursing Facility: | Unknown |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | 20% Coinsurance |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | 20% Coinsurance |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | 20% Coinsurance |
| Outpatient group therapy: | 20% Coinsurance |
| Inpatient psychiatric hospital care: | Coming Soon |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | 20% Coinsurance |
| Occupational therapy: | 20% Coinsurance |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | 20% Coinsurance |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | 20% Coinsurance |
| Lab services: | 20% Coinsurance |
| Outpatient x-rays: | 20% Coinsurance |
| Diagnostic tests and procedures: | 20% Coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | 20% Coinsurance |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Not Covered |
| Hearing aids | Not Covered |
| Hearing exam | Not Covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | 20% Coinsurance |
| Routine eye exam (in-network) | Not Covered |
| Eyewear benefits | None |
Do you have questions about the costs in this plan? Call 1-833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this Special Needs Plan (H4869-012-0) and other plans on this site.
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $30.10 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before Gold Kidney Health Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Gold Circle Dialysis has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Cost data not available. | ||
| *Deductible does not apply. | ||
CMS 5-Star Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage HMO-POS C-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Gold Kidney Health Plan plan.
CMS Star Ratings for Plan H4869-012-0 – 2025
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Eligibility Criteria for Enrolling in Gold Circle Dialysis
To enroll in Gold Circle Dialysis , you must meet the following criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You have been diagnosed with one or more severe or disabling chronic conditions.
This plan is for individuals requiring dialysis (any mode of dialysis).
SNP Plan Enrollment Periods
After confirming your eligibility for Gold Circle Dialysis , it’s essential to understand when you can enroll or make changes to your Medicare plan. The following enrollment periods are important to understand and mark on your calendar
- Initial Enrollment Period (IEP): The first time you can enroll in Medicare, typically around your 65th birthday.
- Annual Enrollment Period (AEP): Occurs yearly and allows you to make changes to your Medicare coverage.
- Special Enrollment Periods (SEPs): Special circumstances, such as moving or losing other coverage, may qualify you to enroll outside of the usual periods.
For more details on enrollment periods, you can learn more here and make sure you’re well-informed about your Medicare choices.
Contact Gold Kidney Health Plan
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this plan and other plans on this site. You may also Enroll Online.
| Contact Type | Details |
|---|---|
| Website: | Gold Kidney Health Plan Plan Page |
| Providers: | Gold Kidney Health Plan Providers Page |
| Formulary: | Gold Kidney Health Plan Formulary Page |
| Pharmacy: | Gold Kidney Health Plan Pharmacy Page |
| New Member Health Plan Help: | (888)376-6188 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (888)376-6188 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or Medicare.gov.
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Gold Kidney Health Plan Official Plan Details – 2025
Official webpage by Gold Kidney Health Plan detailing the Aetna Medicare Preferred (HMO D-SNP) plan benefits, coverage, and enrollment options.
Source Webpage: https://goldkidney.com -
CMS Medicare Advantage and Prescription Drug Plan Landscape Files – 2025
Official CMS dataset detailing Medicare Advantage and Prescription Drug plans for 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: cy2025-landscape-202412.zip
Source Webpage: CMS Medicare Coverage: Prescription Drug Coverage -
CMS Medicare Star Ratings Data Tables – 2025
Official CMS Star Ratings dataset providing performance ratings for Medicare plans for 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: 2025-star-ratings-data-tables.zip
Source Webpage: CMS Part C and D Performance Data -
CMS Plan Benefits Package (PBP) Files – 2025
Official CMS dataset providing detailed plan benefit information for Medicare Advantage plans in 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: pbp-benefits-2025.zip
Source Webpage: CMS Medicare Advantage and Part D Benefits Data