Health Plan Cost Sharing & Benefits

Gold Health 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.

Prescription Drug Plan Costs & Benefits

Prescription Drug Plan Premium

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

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $0.00. 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 Health has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.

CMS 5-Star Rating Marks

Each year, Medicare Advantage HMO-POS C-SNPs are rated by the Centers for Medicare & Medicaid Services (CMS) across nine categories using a 5-star system. These star ratings are designed to help you assess the quality of care and service offered by this Gold Kidney Health Plan plan.

Eligibility Criteria for Enrolling in Gold Health

To enroll in Gold Health, you must meet the following criteria:

1. You are eligible for Medicare;
2. You reside within the plan’s service area; and
3. You have been diagnosed with one or more severe or disabling chronic conditions.

This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes.

Important Enrollment Periods

Once you’ve confirmed your eligibility for Gold Health, it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:

• Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
• Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
• Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.

To get a deeper understanding of these enrollment periods, click here to learn more and stay informed about your Medicare choices.

Contact Gold Kidney Health Plan

If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or Medicare.gov.