Gold Kidney Health Plan

What Gold Kidney Health Plan does

Gold Kidney Health Plan is a privately held Medicare Advantage organization offering Chronic Condition Special Needs Plans (C-SNPs) designed for Medicare beneficiaries with end-stage renal disease (ESRD), chronic kidney disease (CKD), diabetes, cardiovascular disorders, and chronic heart failure. Incorporated in Delaware as Gold Kidney Health Plan Inc. and headquartered in Scottsdale, Arizona, the company operates under an HMO-POS C-SNP model with CMS Medicare contracts in Arizona and Florida. The company was founded by a group of over 100 nephrologists to address the limited availability of specialized plans for patients with chronic kidney and cardiorenal conditions, and as of 2023 offered the only ESRD C-SNP available in Arizona.

The company's core product is the HMO-POS C-SNP Medicare Advantage Plan, which integrates Part C medical coverage and Part D prescription drug coverage administered through MedImpact. Member benefits are structured around chronic-condition needs and include $0 copay dialysis via DaVita, in-home staff-assisted dialysis (Gold Assist), transportation, Flex Card allowances for utilities and OTC items, dental/vision/hearing coverage, a smartphone benefit, and the Silver&Fit wellness program. Revenue derives from risk-adjusted capitation payments from CMS and Medicare Advantage premiums, with 2025 LIS members paying $0 drug plan premium, $0 deductible, and reduced copays of $4.50 (generic) / $11.20 (brand).

Gold Kidney's technology stack is built around CMS interoperability compliance and operational tooling rather than proprietary IP. The AaNeel Connect Patient Portal—hosted by partner AaNeel Infotech—provides members with claims, coverage, clinical summary, prescription, and provider data access via Patient Access APIs. Claims submission runs through Availity, electronic funds transfer via Zelis, and Part D pharmacy through MedImpact. The company's distribution relies on licensed insurance brokers, Medicare enrollment events, a member portal, and phone sales, supported by a regional provider network that includes Banner Health, DaVita, Moffitt Cancer Center, BayCare, Tenet, Abrazo, Carondelet, and MultiPlan. Gold Kidney has raised approximately $64.6M in disclosed funding, led by a $60M round from Chicago Pacific Founders in December 2022.

Name

Gold Kidney Health Plan

Legal name

Gold Kidney Health Plan Inc.

Website

https://goldkidney.com

Company type

Private

Founded year

2021

Operating status

Operating

Headcount range

51–100 employees

Short description

Gold Kidney Health Plan is a privately held Medicare Advantage insurer offering Chronic Condition Special Needs Plans (C-SNPs) for beneficiaries with ESRD, CKD, diabetes, cardiovascular disorders, and chronic heart failure in Arizona and Florida.

Ownership category

akta.pro rank

Product category

Medicare Advantage Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)

akta.pro primary industry

Chronic Condition Special Needs Plans (C-SNP) (FSAIAGAE)

akta.pro secondary industries

Chronic Condition Special Needs Plans (C-SNP) (HLAEAGAA), C-SNP Condition Categories (Diabetes/CVD/CHF/COPD/ESRD/etc.) (HLAEAGAC), Medicare Quality, Risk Adjustment & Stars Analytics/Services (FSAIAGAJ)

Keywords

• Medicare Advantage plans
• Chronic Special Needs Plans
• Kidney disease insurance
• Prescription drug coverage
• ESRD health coverage

Headquarters

HQ city

Scottsdale

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Marketing or Sales, Technology or R&D, Infrastructure

Revenue model

1. Medicare Advantage Premiums: Revenue generated from Medicare Advantage plan premiums, including Medicare Part C medical coverage and Part D prescription drug coverage. Plans are designed as Chronic Condition Special Needs Plans (C-SNP) for beneficiaries with ESRD, CKD, diabetes, cardiovascular disorders, and chronic heart failure.
2. Government Capitation Payments: Risk-adjusted capitated payments from CMS (Centers for Medicare and Medicaid Services) based on the health profile and enrollment of covered beneficiaries.
3. Medicare Part D Drug Coverage: Prescription drug coverage through MedImpact pharmacy benefit manager, generating revenue through prescription copayments and CMS drug plan reimbursements.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels6 records

Core offering

Gold Kidney Health Plan is a Medicare Advantage insurer offering Chronic Condition Special Needs Plans (C-SNPs) — HMO-POS plans tailored for beneficiaries with end-stage renal disease (ESRD), chronic kidney disease (CKD), diabetes, cardiovascular disorders, and chronic heart failure. Plans bundle medical coverage (Part C) with prescription drug coverage (Part D) and supplemental benefits such as $0 copay dialysis, transportation, dental, hearing, vision, and a Flex Card. The company operates as a licensed insurer in Arizona and Florida under CMS contracts.

Product overview

Gold Kidney Health Plan is a Medicare Advantage organization offering Special Needs Plans (C-SNPs) specifically designed for Medicare beneficiaries with chronic conditions including end-stage renal disease (ESRD), chronic kidney disease (CKD), diabetes, cardiovascular disorders, and chronic heart failure. The company operates an HMO-POS C-SNP model with Medicare contracts for both medical services and Part D prescription drug coverage. The product portfolio centers on the core HMO-POS C-SNP Medicare Advantage Plan, which is supported by a suite of digital tools and member services including the Member Portal, Provider Portal, Broker Portal, and AaNeel Connect patient-facing platform. Additional offerings include supplemental benefits (Flex Card, dental, hearing, vision, transportation, PERS), pharmacy services (in-house search, mail-order through Birdi), wellness programs (Silver&Fit partnership, Gold Rewards), and care management tools (Gold Assist in-home dialysis, Medication Therapy Management). The company utilizes AaNeel Infotech for technology infrastructure, Availity for claims submission, Zelis for electronic funds transfer, and MedImpact for Part D pharmacy management.

Differentiator

Problem solved

Functional benefit

Products and services

• HMO-POS C-SNP Medicare Advantage Plan A Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) for Medicare beneficiaries with ESRD, CKD, diabetes, cardiovascular disorders, or chronic heart failure. Coordinates care across nephrologists, dialysis centers, primary care, cardiologists, endocrinologists, and hospitals; reduces referrals; offers $0 copay dialysis, transportation, supplemental dental, hearing, vision, Flex Card allowances, smartphone benefit, and personal emergency response system.
• Medicare Part D Prescription Drug Coverage Medicare Part D prescription drug coverage integrated with Gold Kidney's Medicare Advantage plans, administered through MedImpact pharmacy benefit manager. Provides access to covered drugs, mail-order pharmacy services via Birdi, Extra Help/Low Income Subsidy cost reductions, and Medication Therapy Management for chronic condition members.

Quantifiable outcome

• Prior authorization approval rate: 94% for standard requests (Arizona), 93% for standard requests (Florida)
• +1 more outcomes

Named customers7 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

Feature3 records

Partnerships

14 partnerships are on record, tiered strategic, core and minor.

• Moffitt Cancer CenterstrategicOthers · 5 December 2024Moffitt Cancer Center joined Gold Kidney's provider network in December 2024, providing Florida members with access to world-class cancer care. Moffitt is one of only 57 NCI-designated Comprehensive Cancer Centers. Locations include Tampa, Wesley Chapel, and Southshore.
• Banner HealthcoreOthersBanner Health is an in-network provider partner for Gold Kidney Health Plan members, providing healthcare services as part of the coordinated care model for patients with chronic kidney disease and related conditions.
• DaVita DialysiscoreOthersDaVita Dialysis is a provider partner offering dialysis services to Gold Kidney members, with benefits including $0 copay dialysis as part of the kidney-focused Medicare Advantage plans.
• AaNeel InfotechcoreTechnology or IntegrationAaNeel Infotech provides and maintains Gold Kidney's CMS-compliant Patient Access APIs and hosts the AaNeel Connect platform, enabling members to securely access their health information including claims, coverage details, clinical summaries, prescriptions, and provider information.
• MultiPlancoreOthersGold Kidney utilizes the MultiPlan Medicare Advantage Network in Florida. MultiPlan providers are approved to submit claims to Gold Kidney and appear in provider search results with the MultiPlan logo.
• BayCarecoreOthersBayCare is a new in-network provider partner for Gold Kidney Health Plan members in Florida.
• Tenet HealthcoreOthersTenet Health is a new in-network provider partner for Gold Kidney Health Plan members.
• Abrazo HealthcoreOthersAbrazo Health is a new in-network provider partner for Gold Kidney Health Plan members.
• Carondelet HealthcoreOthersCarondelet Health is a new in-network provider partner for Gold Kidney Health Plan members.
• AvailitycoreTechnology or IntegrationGold Kidney offers electronic claims submission through Availity. Availity payer ID for Gold Kidney is A6865.
• ZeliscoreTechnology or IntegrationGold Kidney offers Electronic Funds Transfer (EFT) through Zelis, shortening the reimbursement cycle and streamlining the claims payment workflow for providers.
• MedImpactcoreOthersMedImpact is the pharmacy benefit manager (PBM) for Gold Kidney's Medicare Part D prescription drug coverage. Handles Part D grievances, appeals, and coverage determinations.
• BeneLynkminorOthersBeneLynk provides advocacy services to help Gold Kidney members enroll in government programs including Medicare Savings Program (MSP) and Low-Income Subsidy (LIS/Extra Help) at no cost to members.
• Silver&FitminorOthersGold Kidney partners with Silver&Fit to provide the Healthy Aging and Exercise program to members, including gym membership, personalized workout plans, fitness kits, on-demand workout videos, and the Silver&Fit Connected! tool to track activities through fitness apps or wearable devices.

Scale indicators4 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• Humana: One of the largest Medicare Advantage insurers in the US with a broad portfolio that includes C-SNPs and condition-specific plans for chronic populations, directly competing with Gold Kidney for senior beneficiaries with kidney disease and other chronic conditions.
• UnitedHealthcare: The largest Medicare Advantage carrier in the US, offering a broad set of MA plans including C-SNPs; competes with Gold Kidney for chronic-condition seniors in Arizona and Florida and represents the principal large-plan competitive threat.
• CVS Health (Aetna): Aetna's Medicare Advantage business, integrated with CVS retail and Caremark PBM, offers C-SNPs and chronic-condition plans that overlap directly with Gold Kidney's ESRD, diabetes, and cardiovascular C-SNP positioning.
• Elevance Health (Anthem): Major diversified insurer operating Blue Cross Blue Shield plans with sizable Medicare Advantage and C-SNP businesses; a broad incumbent competitor that can scale C-SNP offerings across multiple geographies quickly.
• Centene: Large managed care insurer with a meaningful Medicare Advantage book (Wellcare) including SNPs; competes with Gold Kidney in serving government-program, chronic-condition populations across multiple states.

Direct peers

• Alignment Health: Tech-enabled Medicare Advantage insurer focused on seniors with chronic conditions, particularly in California and select expansion states; comparable to Gold Kidney as a smaller, technology-forward MA carrier targeting high-acuity populations.
• Devoted Health: Medicare Advantage insurer built around a tech-enabled care model for seniors with chronic conditions, expanding across multiple states; closely mirrors Gold Kidney's combination of tech stack, chronic-condition focus, and growth-stage scaling.
• SCAN Health Plan: Nonprofit Medicare Advantage plan with deep roots serving seniors with chronic and complex care needs, including chronic condition SNPs; comparable to Gold Kidney in its focus on high-acuity seniors and care coordination for chronic disease.
• Clover Health: Tech-forward Medicare Advantage insurer using its Clover Assistant software platform to support primary care providers managing MA members; similar to Gold Kidney in pairing a SaaS-style clinical platform with an MA insurance license.
• Bright Health Group: Smaller-scale Medicare Advantage insurer that has scaled C-SNP and individual MA products in select states; comparable to Gold Kidney as a focused MA challenger navigating capital constraints and competition from national incumbents.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• YouTubeyoutube.com/@GoldKidneyhealth
• Facebookfacebook.com/people/Gold-Kidney-Health-Plan-Inc/100081533395941
• LinkedInlinkedin.com/company/gold-kidney-health-plan

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Subsidiaries1 record

Funding overview

Funding rounds2 records

Investors1 record

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Gold Kidney Health Plan