Gold Heart & Diabetes Plus (HMO-POS C-SNP) Medicare Special Need Plan H1526-012 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4100.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $0.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 0 beneficiaries
Introduction
CMS Plan ID H1526-012 identifies Gold Heart & Diabetes Plus, a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Gold Kidney Health Plan. Its provider network is a Health Maintenance Organization with a Point of Service (HMO-POS), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $0.00 monthly premium, $0.00 medical deductible, and $4100.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $0.00.
Enrollment across the plan's service areas totals 0 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
Eligibility
Gold Heart & Diabetes Plus is a Chronic Condition Special Needs Plan (C-SNP) designed for people with qualifying health 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.
Plan Benefits
Gold Heart & Diabetes Plus 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 H1526-012.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: 30% coinsurance |
Coming soon |
| Specialist | In-network: $0-$55 copay Out-of-network: $0-$55 copay |
Coming soon |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | Coming soon |
| Telehealth benefit | In-network: $0 copay | Coming soon |
| Routine chiropractic | In-network: $20 copay | Coming soon |
| Fitness benefits | Coming soon | Coming soon |
| Health education | In-network: $0 copay | Coming soon |
| Counseling services | Not covered | Coming soon |
| Over-the-counter drug benefits | Not covered | Coming soon |
| Health transportation (non-emergency) | Coming soon | Coming soon |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$200 copay Out-of-network: 30% coinsurance |
Coming soon |
| Lab services | In-network: $0-$30 copay Out-of-network: 30% coinsurance |
Coming soon |
| Outpatient x-rays | In-network: $0 copay Out-of-network: 30% coinsurance |
Coming soon |
| Diagnostic tests and procedures | In-network: $0-$30 copay Out-of-network: 30% coinsurance |
Coming soon |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $120 copay | Coming soon |
| Worldwide emergency care | Coming soon | Coming soon |
| Urgent care | $40 copay | Coming soon |
| Inpatient hospital care | In-network: Tier 1 $220 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 |
Coming soon |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $217 per day for days 21-100 Out-of-network: 20% per stay |
Coming soon |
| Ground ambulance | In-network: $225 copay Out-of-network: 30% coinsurance |
Coming soon |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $25 copay Out-of-network: 30% coinsurance |
Coming soon |
| Outpatient group therapy | In-network: $10 copay Out-of-network: 30% coinsurance |
Coming soon |
| Inpatient psychiatric hospital care | In-network: Tier 1 $220 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: $0 per day for days 1-60 $434 per day for days 61-90 $868 per day for days 91-150 |
Coming soon |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $15 copay Out-of-network: 30% coinsurance |
Coming soon |
| Occupational therapy | In-network: $15 copay Out-of-network: 30% coinsurance |
Coming soon |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 30% coinsurance |
Coming soon |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
Coming soon |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
Coming soon |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
Coming soon |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
Coming soon |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | Coming soon |
| Dental x-rays | In-network: $0 copay | Coming soon |
| Cleaning | In-network: $0 copay | Coming soon |
| Periodontics | In-network: $0 copay | Coming soon |
| Endodontics | In-network: $0 copay | Coming soon |
| Restorative services | In-network: $0 copay | Coming soon |
| Implant services | Not covered | Coming soon |
| Orthodontics | Not covered | Coming soon |
| Oral/Maxillofacial surgery | In-network: $0 copay | Coming soon |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | Coming soon |
| Contact lenses | In-network: $0 copay | Coming soon |
| Eyeglass frames only | In-network: $0 copay | Coming soon |
| Eyeglass lenses only | In-network: $0 copay | Coming soon |
| Eyeglasses (frames & lenses) | In-network: $0 copay | Coming soon |
| Upgrades | Not covered | Coming soon |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | Coming soon |
| Fitting/evaluation | In-network: $0 copay | Coming soon |
| Prescription hearing aids | In-network: $195-$1395 copay | Coming soon |
| OTC hearing aids | Not covered | Coming soon |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Coming soon |
| Home-based palliative care | Not covered | Coming soon |
| Personal emergency response system | Coming soon | Coming soon |
| Weight management programs | Not covered | Coming soon |
| Wigs for chemotherapy-related hair loss | Coming soon | Coming soon |
| Alternative therapies | Not covered | Coming soon |
| Massage therapy | Not covered | Coming soon |
| Home/bathroom safety devices | Not covered | Coming soon |
Certain preventive services are covered 100% by Gold Heart & Diabetes Plus as a Part B benefit.
Prescription Drug Coverage
Gold Heart & Diabetes Plus 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: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $0.00 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 Plus may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Not available |
| Generic | $5.00 copay | Not available |
| Preferred Brand | $45.00 copay | Not available |
| Non-Preferred Brand | 30% coinsurance | Not available |
| Specialty Tier | 33% coinsurance | Not available |
| Select Diabetic Drugs | $0.00 copay | 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.
Plan Availability
Gold Heart & Diabetes Plus (H1526-012-0) is available in the following locations (click to open):
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 | Understanding Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.