Medicare Advantage · C-SNP · HMOPOS · 2027
Gold Heart & Diabetes Complete (HMO-POS C-SNP)
No referral needed to see a specialist
At a glance: $7.30 monthly premium and $4,000/yr preventive & comprehensive dental allowance.
Eligibility required for this C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. See who can enroll
- Monthly premium
- $7.30
- Part B premium separate
- Yearly limit
- $9,750
- Most you’d pay for in-network care
- Dental
- $4,000/yr
- Preventive & comprehensive dental allowance
- Doctor visits
- 20%
- Primary care · specialists 20%
Check this plan for you
Add your doctors and prescriptions to see how they work with this plan.
- DentalPreventive & comprehensive dental allowance
- $4,000/yr
- VisionRoutine vision benefit
- Included
- HearingHearing aid benefit
- Included
- Fitness$0 fitness benefit
- Included
- Transportation22 one-way trips/year
- Included
- MealsMeal benefit
- Included
This is a supplemental benefit with plan-specific limits. See plan documents for details.
Talk to a licensed agent
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and 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.
Talk with a licensed advisor
A licensed agent can review this plan and other plans in your area that fit your needs.
TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST
Who can enroll
Eligibility for this Special Needs Plan
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and 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
- $100/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.
Costs and copays
Deductible, yearly limit, visits and drug tiers
- Drug deductiblePer year
- $700
- Yearly limitIn-network care, not counting drugs
- $9,750
- Primary doctorPer visit
- 20%
- SpecialistPer visit · no referral needed
- 20%
- Outpatient surgeryPer procedure
- 20%
- Emergency roomPer visit
- 20% (max $115/visit)
- Urgent carePer visit
- 20% (max $40/visit)
- Tier 1 · Preferred Generic30-day supply at a retail pharmacy
- 25%
Our take
Where this plan shines, and what to know
Where this plan shines
- Some out-of-network care is covered (HMO-POS).
Things to know before you enroll
- This plan’s out-of-pocket maximum is above the national median.
- Limited coverage while traveling outside the plan’s service area.
Similar plans
Other Medicare Advantage plans offered in Florida
Browse the full 2027 Chronic Condition Special Needs Plan directory. This plan is offered in Florida. Plan availability can vary by county.
More Chronic Condition Special Needs Plan options
These plans are offered in at least one of the same states. Check your ZIP or county before choosing a plan.
- Gold Dialysis & Kidney (HMO-POS C-SNP)Gold Kidney Health Plan · H1526-003Offered in Florida
- Gold Dialysis & Kidney (HMO-POS C-SNP)Gold Kidney Health Plan · H1526-009Offered in Florida
- Gold Dialysis & Kidney Complete (HMO-POS C-SNP)Gold Kidney Health Plan · H1526-004Offered in Florida
- Gold Dialysis Premier (HMO-POS C-SNP)Gold Kidney Health Plan · H1526-010Offered in Florida
- Gold Dialysis Premier (HMO-POS C-SNP)Gold Kidney Health Plan · H1526-011Offered in Florida
- Gold Heart & Diabetes (HMO-POS C-SNP)Gold Kidney Health Plan · H1526-001Offered in Florida
Common questions
6 answers about this plan
What does Gold Heart & Diabetes Complete (HMO-POS C-SNP) (HMOPOS) cover?
Gold Heart & Diabetes Complete (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. Its published drug benefit lists 1 formulary tiers. Published supplemental benefits include dental ($4,000/yr preventive & comprehensive dental allowance), vision (Routine vision benefit), hearing (Hearing aid benefit), and fitness ($0 fitness benefit). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.
Learn about Medicare AdvantageHow much does Gold Heart & Diabetes Complete (HMO-POS C-SNP) (HMOPOS) cost in 2027?
The published 2027 monthly plan premium for Gold Heart & Diabetes Complete (HMO-POS C-SNP) (HMOPOS) is $7.30. Any Medicare premiums you owe are separate from the listed plan premium. The listed Part D deductible is $700. The in-network medical out-of-pocket maximum is $9,750; it does not include Part D drug spending. Published visit costs include primary care 20% and specialist visits 20%. These figures are plan data, not a personal yearly-cost estimate.
Understand Medicare drug-cost limitsCan I use my current doctors with Gold Heart & Diabetes Complete (HMO-POS C-SNP) (HMOPOS)?
CMS lists Gold Heart & Diabetes Complete (HMO-POS C-SNP) (HMOPOS) as a HMOPOS plan. The plan record says specialist referrals are not required. 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 doctorsWhat chronic conditions qualify for Gold Heart & Diabetes Complete (HMO-POS C-SNP) (HMOPOS)?
Gold Heart & Diabetes Complete (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 Cardio DIS CHF and 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 PlansHow does Gold Heart & Diabetes Complete (HMO-POS C-SNP) (HMOPOS) coordinate care for my chronic condition?
Gold Heart & Diabetes Complete (HMO-POS C-SNP) (HMOPOS) is identified in the current plan record as a Chronic Condition Special Needs Plan for qualifying conditions that include Cardio DIS CHF and Diabetes. The record also lists dental ($4,000/yr preventive & comprehensive dental allowance), vision (Routine vision benefit), and hearing (Hearing aid benefit). 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 Complete (HMO-POS C-SNP) (HMOPOS)?
Gold Heart & Diabetes Complete (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 periodsPlan documents
Summary of Benefits and Evidence of Coverage
- Summary of Benefits (PDF)Download the plan's official Summary of Benefits document
- Evidence of Coverage (PDF)Complete plan details and rules
- Check Your DoctorsSee if your doctors accept this plan
- Documentos en españolLlame a The Pocket Protector al 1-866-764-3312 (TTY: 711) para recibir ayuda con documentos en español
Talk to a licensed agent
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and 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.
Talk with a licensed advisor
A licensed agent can review this plan and other plans in your area that fit your needs.
TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST
