Gold Heart & Diabetes Complete (HMO-POS C-SNP) H1526-002 • 2027 • Clay County, FL
- Monthly Premium
- $7.30Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9750.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Clay County, FL
- Local Enrollment
- 0 beneficiaries in Clay County
Introduction
Gold Heart & Diabetes Complete is a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Gold Kidney Health Plan. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $7.30 monthly premium, $0.00 medical deductible, and $9750.00 in-network maximum out-of-pocket. CMS Plan ID H1526-002 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
This plan is available to eligible residents of Clay County, Florida. CMS reports 0 beneficiaries enrolled in this plan in Clay County. For assistance with this plan, new members can call (844)294-6535 (TTY 711).
Eligibility
Gold Heart & Diabetes Complete is a Medicare C-SNP plan for individuals with specific chronic or disabling conditions.
- Special Needs Plan Type
- Chronic Condition Special Needs Plan (C-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes mellitus.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Clay County
Compare this plan with the two most-enrolled HMO-POS C-SNP plans available in Clay County, Florida. Enrollment is based on CMS local enrollment data.
| Plan Detail | Gold Heart & Diabetes Complete | Gold Heart & Diabetes | Gold Dialysis & Kidney |
|---|---|---|---|
| CMS Plan ID | H1526-002-0 |
H1526-001-0 |
H1526-003-0 |
| Local Enrollment | 0 | 180 | 17 |
| Monthly Premium | $7.30 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $9,750.00 | $2,700.00 | $3,400.00 |
| Part B Giveback | Not offered | −$133.00 reduction | Not offered |
| Primary Care | 20% coinsurance | $0 copay | $0 copay |
| Specialist | 20% coinsurance | $0-$55 copay | $0-$35 copay |
| Part D Deductible | $700.00 | $0.00 | $0.00 |
| CMS Star Rating | 2.5 | 2.5 | 2.5 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Gold Heart & Diabetes Complete has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H1526-002.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H1526-002-0 Cost Compare.
Office Visits
- Primary care
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance - Specialist
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: 20% coinsurance
- Routine chiropractic
- In-network: 20% coinsurance
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance - Lab services
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance - Outpatient x-rays
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance - Diagnostic tests and procedures
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- 20% coinsurance
- Worldwide emergency care
- Coming soon
- Urgent care
- 20% coinsurance
- Inpatient hospital care
- In-network:
Tier 1
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150
Out-of-network:
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150 - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$217 per day for days 21-100
Out-of-network: - Ground ambulance
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance - Outpatient group therapy
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150
Out-of-network:
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance - Occupational therapy
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: 30% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: $0 copay
- Endodontics
- In-network: $0 copay
- Restorative services
- In-network: $0 copay
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $0 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Gold Heart & Diabetes Complete as a Part B benefit.
Prescription Drug Coverage
Gold Heart & Diabetes Complete includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $7.30 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $7.30 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $7.30 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Gold Kidney Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Gold Heart & Diabetes Complete may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Not available |
| Generic drugs | 25% coinsurance | Not available |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H1526)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Gold Kidney Health Plan
- 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
- (844)294-6535
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)294-6535
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Gold Kidney Health Plan (official source) | http://goldkidney.com | October 4, 2026 |
| CMS.gov | Chronic Condition Special Needs Plans (C-SNPs) | April 28, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | April 28, 2026 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | April 28, 2026 |
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