ARIZONA

Gold Heart & Diabetes

For those who are Medicare-eligible with cardiovascular disorders, chronic heart failure, and/or diabetes.

Monthly Premium
$ 0
Part B PREMIUM REBATE
$ 0
Maximum Out-of-Pocket
$ 0

Deductible

$0
This is what you will pay before Gold Kidney starts paying for covered medical expenses

Primary care copay

$0
This is what you will pay for a visit to your primary doctor

Specialist copay*

$10
This is what you will pay for endocrinologists, nephrologists, cardiologists, and cardiovascular and vascular surgeons visits

Inpatient hospitalization

$150 (days 1-5) $0 (days 6-90)
This is what you will pay if you require hospital admission

Outpatient surgery

$125
This is what you will pay for medical services that don't require an overnight hospital stay

Rx deductible

$0
This is what you will pay before Gold Kidney starts paying for covered prescribed medication

30-day Rx copay
(Tiers 1-6)

$0/$0/$40/ $100/33%/$0
This is what you will pay for prescription medications

100-day mail order Rx
(Tiers 1–6)

$0/$0/$40/ $100/33%/$0
This is what you will pay for a long-term supply of prescription medications through convenient mail-order service

*Cardiology, nephrology, endocrinology, and cardiovascular and vascular surgeons; all other specialists have $0 copay 

Additional Benefits**

**Refer to the Summary of Benefits for specific benefits and coverage amounts

  • $4,000 annual Flex allowance for dental, vision, and hearing, with rollover
  • 24 one-way trips for non-emergency transportation
  • $300 annually for over-the-counter items, fitness fees, and more
  • In-home companion care
  • Personal emergency response system available
  • $840 annually for healthy food and produce (SSBCI)
  • Worldwide emergency travel coverage
goldie new plans - 2025

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