Humana Gold Plus HMO D SNP

Understanding the benefits of the Humana Gold Plus HMO D-SNP plan is crucial if you’re dual-eligible for Medicare and Medicaid.

This article provides a straightforward overview of the core Humana Gold Plus HMO D-SNP benefits, enrollment guidelines, and cost-saving features the plan offers its members. Discover how to fully utilize your healthcare coverage, the prescription drug benefits included, and the additional perks that set this plan apart from others.


Key Takeaways


  • Eligibility for the Humana Gold Plus HMO D-SNP plan requires enrolment in Medicare Part A and B, Medicaid benefits, and adherence to criteria set for income and assets; the plan is non-discriminatory and provides special enrollment periods.


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Understanding Humana Gold Plus HMO D-SNP

The Humana Gold Plus HMO D-SNP is a Medicare Advantage HMO plan tailored for individuals who qualify for both Medicare and Medicaid. Intricately woven, the plan’s fabric includes a Healthy Options Allowance that helps cover expenses like food, pet supplies, utility bills, or rent, as well as access to lower-cost preferred pharmacies.

With the variety of options available, it’s essential to understand the differences between Medicare Advantage HMO PPO plans to make the best choice for your healthcare needs.


Understanding Humana Gold Plus HMO D-SNP (1)

The primary recipients of this plan include:


  • FBDE
  • QDWI
  • QI
  • QMB
  • QMB+
  • SLMB
  • SLMB+


The plan is available in states like ny oh or pa. It encompasses specialized benefits like prescription drug coverage and free language interpreter services for non-English speaking members, ensuring that you get the care you need, when you need it.


Eligibility Criteria for D-SNP

Eligibility for a D-SNP plan like Humana Gold Plus HMO D-SNP requires individuals to be enrolled in both Medicare Part A and Part B, in addition to receiving Medicaid benefits. This is true for states like CA, CT, DC, and DE where the plan is available.

As long as you’re 21 years of age or older, and you meet the income and asset criteria set for Medicaid, you are eligible for D-SNP, regardless of your race, color, or national origin.

Moreover, D-SNP is not just for U.S. citizens. If you’re a lawful permanent resident, you can qualify, regardless of your race, color, national origin, age, disability, or sex. Even individuals with national origin age disability can be eligible for D-SNP if they meet the criteria of being dual eligible for both Medicare and Medicaid, regardless of their disability, sex, or sexual orientation.


Enrollment Periods and Procedures

The D-SNP enrollment process entails eligibility verification, application completion and confirmation, along with any additional required steps, adhering to non-discrimination principles based on origin, age, disability, sex, sexual orientation, gender, or sexual orientation gender identity, including disability sex sexual orientation.

The enrollment process varies slightly for newcomers compared to existing beneficiaries. For newcomers, it entails signing up online, contacting Social Security, or completing an online application. On the other hand, existing beneficiaries may need to select a plan, submit an application directly to the plan, or initiate a telephonic enrollment, without discrimination based on sex, sexual orientation, or gender.

To complete the enrollment process, it is necessary to submit the application electronically through the Health Plan Management System (HPMS) to CMS. In California (ca ct dc de), D-SNPs are required to have executed contracts with the Department of Health Care Services (DHCS), the state Medicaid agency, without discrimination based on color, national origin, or age.

Additionally, the agency ensures compliance with regulations across multiple states, including md me mi mn.

Furthermore, there are designated special enrollment periods for the Humana Gold Plus HMO D-SNP plan. These periods afford the opportunity to enroll in or change a Medicare Advantage plan outside of the Initial Coverage Election Period (ICEP) or the annual Medicare Open Enrollment Period, without discrimination based on national origin, age, or disability.

Tailored Health Coverage

The Humana Gold Plus HMO D-SNP plan offers:


  • A tailored solution instead of a one-size-fits-all approach
  • Personalized, integrated care that caters to the distinct health requirements of individuals enrolled in both Medicare and Medicaid, without discrimination based on age, disability, sex, or sexual orientation
  • Coordinated care through a Medicare contract and a contract with the state Medicaid program


This approach emphasizes the coordination of various care services to deliver comprehensive healthcare, without discrimination based on identity or expression transgender status marital.


Humana gold plus hmo d-snp benefits 2024 form



The network of providers in Humana Gold Plus HMO D-SNP is significant as it ensures that members have access to a wide range of healthcare services and support, all of which are outlined in the plan’s guides for better health and medication management, without discrimination based on identity or expression, including transgender individuals.


Coordinated Care Approach

With an aim to improve health outcomes and reduce expenses, the coordinated care approach delivers high-quality, personalized healthcare, treating all patients equally, regardless of their military or veteran status.

It aligns services with patients’ needs and preferences, ensuring that high-quality care is delivered in an efficient and effective manner, without discrimination based on status, military, or veteran status.

Through the use of their Medicare contract and a network of healthcare providers, Humana Gold Plus HMO D-SNP ensures an appropriate level of care for its members, irrespective of their veteran status or religion. This approach not only prevents unnecessary admissions, emergency department visits, and duplicate tests and procedures, but also ensures that care is appropriate and timely, without discrimination based on gender identity or expression.


Network of Providers

Healthcare providers within the Humana Gold Plus HMO D-SNP network can be located by utilizing the online searchable directory available on the Humana website. This directory allows users to search for providers by:


  • Name
  • Condition
  • Specialty
  • Other relevant criteria


The network includes a wide range of health care providers including dentists and optometrists.

To change providers within the network, members can make use of Humana’s online search tools or consult the printed directories. Alternatively, you may also seek assistance from a Member Services specialist to locate a new in-network provider, including mental health therapists.

Prescription Drug Benefits

Humana Gold Plus HMO D-SNP provides prescription drug coverage as a component of its Medicare Advantage plan, encompassing a range of medications specified in the Humana Drug List, also referred to as the formulary.

The medication therapy management program offered by Humana Gold Plus HMO D-SNP provides a thorough assessment of medications to enhance therapeutic results, delivering guidance to patients on optimizing their medication regimen, particularly for individuals using multiple medicines.


Humana gold plus hmo d-snp providers



Specialty pharmacies have a crucial function within the Humana Gold Plus HMO D-SNP as they oversee treatments for chronic and complex illnesses and offer a comprehensive health approach, which forms an essential component of the members’ prescription drug benefits. And, to obtain their prescription drugs, members can log into MyHumana, search for drugs to confirm coverage by their plan and price their prescriptions, as part of the convenience offered by the prescription drug benefits.


Medication Therapy Management

Designed to optimize medication use and enhance health outcomes, the medication therapy management program plays a pivotal role. This is achieved by ensuring optimal therapeutic results, minimizing the risk of adverse events, and reducing overall healthcare expenses.

To be eligible for the medication therapy management program, individuals must satisfy specific eligibility criteria and are projected to have annual Part D medication expenses of $4,696 in 2022. This mandatory program is integrated into the benefit structure of Humana Gold Plus HMO D-SNP and all Part D Sponsors, making it a significant value proposition.


Specialty Pharmacy Access

A specialty pharmacy is dedicated to providing high-cost, high-touch medication therapy for patients with complex disease states. It operates as a state-licensed pharmacy that primarily or exclusively dispenses medications for individuals with significant health conditions.

By providing access to intricate and high-cost medications that are crucial for the management of severe health conditions, specialty pharmacies offer substantial benefits to Humana Gold Plus HMO D-SNP members.

Examples of such intricate and high-value medications offered by specialty pharmacies include Zolgensma, which is utilized for the treatment of spinal muscular dystrophy, and Harvoni, which is a cure for Hepatitis C.

These specialty pharmacies also offer services including the delivery of medications to a preferred location, support in identifying financial assistance programs, and condition-specific services to provide additional support.

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Additional Perks and Services

In addition to providing a Healthy Foods card, Humana Gold Plus HMO D-SNP also offers special benefits like prescription drug coverage. Wellness programs constitute a significant component of these supplementary benefits.

These wellness programs of Humana Gold Plus HMO D-SNP prioritize preventive health by offering incentives for screenings and activities, as well as providing access to the SilverSneakers® fitness program and basic fitness services.

The transportation services offered by Humana Gold Plus HMO D-SNP encompass coverage for ambulance transports to medical facilities in emergencies and routine medical transportation for healthcare visits such as dialysis, chemotherapy, and postpartum care.

Moreover, Humana offers unique benefits including unlimited PCP visits, the ability to select a new PCP, and potential telehealth services. Additionally, it provides financial assistance for Medicare Part A and B premiums through the Qualified Medicare Beneficiary (QMB) program.


Wellness Programs

Designed to promote and enhance the health of members, Humana Gold Plus HMO D-SNP offers a wide variety of wellness programs. These programs provide an incentive program to encourage completion of specific preventive health screenings.

To access and participate in the wellness programs offered by Humana Gold Plus HMO D-SNP, individuals must meet the eligibility criteria for both Medicare and Medicaid and reside in a state where D-SNPs are available. Furthermore, they have the option to utilize fitness facilities and classes through the SilverSneakers program.


Transportation Services

Coverage for non-emergency medical transportation services may be included in the Humana Gold Plus HMO D SNP plan, however, it is advisable to review the plan benefits for further details. Humana Gold Plus HMO D-SNP members may qualify for non-emergency medical transportation services when they require transportation to the hospital, critical access hospital, or skilled nursing facility.


What is the humana gold plus plan



Humana Gold Plus HMO D-SNP offers coverage for ground ambulance transportation for individuals needing transportation to a hospital, critical access hospital, or skilled nursing facility. Moreover, Medicare may cover restricted, medically necessary, nonemergency ambulance transportation for Humana Gold Plus HMO D-SNP members with a written order from their healthcare provider.

To arrange non-emergency medical transportation, Humana Gold Plus HMO D-SNP members can contact their local taxi service or inquire with Humana to explore available transportation options including car, van, taxi, or wheelchair.

Rights and Protections

As detailed in Humana’s rights and responsibilities statement, members of Humana Gold Plus HMO D-SNP are entitled to specific rights and responsibilities. This statement serves as a reminder to both members and healthcare providers regarding their respective roles in fostering a constructive partnership.

To commence the grievance and appeals process, individuals can contact the Customer Care phone number specified on their Humana ID card. Additionally, they have the option to submit an appeal or grievance through the online platform. It is important to note that standard appeal requests should be initiated within 60 days from the initial determination or claim denial date.

Language assistance is a critical part of the rights and protections offered to Humana Gold Plus HMO D-SNP members. Humana Gold Plus HMO D-SNP offers comprehensive language assistance services to all members, aiming to ensure equal access to healthcare. These services include language assistance and multi-language interpreter services, provided at no cost.


Grievance and Appeals Process

To commence the grievance and appeals process, you may contact the Customer Care phone number on your Humana ID card or directly dial 800-457-4708 (TTY: 711) between 8 a.m. and 8 p.m. Eastern time. Alternatively, there are options to submit an appeal or grievance online, or via fax or mail to Humana Grievances and Appeals at P.O. Box 14165, Lexington, KY 40512-4165. Humana Gold Plus HMO D-SNP ensures that grievances are resolved within a maximum of thirty (30) calendar days.

During the grievance and appeals process with Humana Gold Plus HMO D-SNP, policyholders have the right to request an appeal, file a grievance, or appoint a representative. Additionally, they are able to file a formal complaint or appeal without the risk of being disenrolled.


Language Assistance and Accessibility Support


Humana gold plus hmo d-snp benefits 2023 2024



Support is provided for members who have limited English proficiency or disabilities. Humana Gold Plus HMO D-SNP provides the following language assistance services for all members to ensure equal opportunity for meaningful access to healthcare:


  • Translation services
  • Interpretation services
  • TTY/TDD services
  • Accessible formats for documents and materials


For members who do not have a strong command of the English language, Humana offers language assistance services, providing access to interpreters who can be contacted at 1-877-320-1235 (TTY: 711) free of charge.

Cost Considerations

Compared to other types of plans, Humana Gold Plus HMO D-SNP plans typically come with:


  • Lower monthly premiums
  • $0 copays for numerous covered prescriptions
  • No deductible
  • No copay for all covered Part D services.


Indeed, once your annual out-of-pocket expenses for prescription drugs reach $7,400, you will have no further costs for any drugs. Additionally, there is a set limit for the maximum out-of-pocket expenses for covered services.


Understanding Your Costs

In the Humana Gold Plus HMO D-SNP plan, the main expenses are:


  • Fixed copayments for covered services and prescription drugs
  • No deductibles
  • A cap on annual out-of-pocket drug expenses
  • Numerous covered prescriptions entail $0 copays, with no deductible or copay for all Part D drugs covered.


There are no deductibles linked to the Humana Gold Plus HMO D-SNP, indicating that members are not required to make an initial out-of-pocket payment before their plan benefits become effective.

The out-of-pocket maximum sets a cap on the annual expenditure for drug costs at $7,400 for members. Once this maximum is reached, members will be relieved from paying for all covered drugs for the remainder of the year, offering substantial savings and financial security.


Savings Opportunities

Aimed at alleviating the financial burden associated with Medicare premiums, deductibles, and prescription copayments, the Extra Help program serves to reduce the financial stress for members of the Humana Gold Plus HMO D-SNP plan. Eligibility for the Extra Help program is determined based on limited income and resources. Individuals must be enrolled in or eligible for a Part D prescription drug plan and must meet specific income and resource thresholds to qualify.

The Humana Gold Plus HMO D-SNP is specifically designed for individuals who are dual-eligible, qualifying for both Medicare and Medicaid. It provides integrated benefits and cost savings through this coordination. Dual eligible participants in Humana Gold Plus HMO D-SNP can avail themselves of $0 copays on numerous covered prescriptions, along with additional special benefits intended to diminish overall healthcare expenses.


To summarize, the Humana Gold Plus HMO D-SNP is a comprehensive plan specifically tailored for individuals eligible for both Medicare and Medicaid. Offering an array of benefits from personalized health coverage to prescription drug benefits and additional perks, it ensures that members receive integrated and coordinated care.

With specific rights and protections in place, members can rest assured of their care and support. The plan also offers various cost savings opportunities, making it a financially viable option for eligible individuals.

Frequently Asked Questions



What are the disadvantages of Humana Gold Plus?

The disadvantages of Humana Gold Plus include limitations within its network, prior authorization requirements, plan restrictions, and potential plan changes. These factors may impact your experience with the plan.


What is the difference between Medicare and Humana Gold?

The main difference between Medicare and Humana Gold is that Medicare is a federal fee-for-service health insurance program, while Humana is a private insurance company that contracts with Medicare to offer benefits to plan members. Humana Gold is a specific Medicare plan offered by Humana.


Is Humana Gold a HMO or PPO?

Humana Gold Plus is a HMO plan, providing the same basic benefits as Original Medicare and possibly some additional benefits.


Who is eligible for the Humana Gold Plus HMO D-SNP plan?

If you qualify for both Medicare and Medicaid, you are eligible for the Humana Gold Plus HMO D-SNP plan.


→  What are the primary benefits of the Humana Gold Plus HMO D-SNP plan?

The primary benefits of the Humana Gold Plus HMO D-SNP plan include personalized health coverage, prescription drug benefits, wellness programs, transportation services, and cost savings opportunities.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.