Gold Heart & Diabetes Complete (HMO-POS C-SNP) Costs & Coverage — Martin County, Florida

Eligibility Requirements

• Gold Heart & Diabetes Complete is a Chronic Condition Special Needs Plan (C-SNP) designed for people with qualifying health conditions.
• This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes.

Plan Network

This plan uses an HMO-POS network, meaning most care is provided by in-network doctors and facilities. Referrals are typically required for specialist visits, but some out-of-network services may be covered at a higher cost. Emergency care and out-of-area dialysis are covered.

Office Visits

This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.

Preventive and Wellness Services

Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.

Diagnostic, Lab, and Imaging Services

Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.

Emergency and Urgent Care Services

Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.

Mental Health Services

Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.

Rehabilitation Services

Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.

Medical Equipment and Supplies

Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.

Medicare Part B Drugs

Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.

Dental Services

Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.

Vision Services

Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.

Hearing Services

Hearing coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.

Additional and Special Needs Services

Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.

Part D Coverage Level (Benefit Design)

Gold Heart & Diabetes Complete includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.

Plan Premium

The following table outlines the prescription drug plan premium details of this plan.

Plan Deductible

The Medicare Part D annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Gold Kidney Health Plan begins paying its share.

Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Gold Heart & Diabetes Complete has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.