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Humana Community HMO SNP-DE (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Community HMO SNP-DE (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Community HMO SNP-DE (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Community HMO SNP-DE (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Jefferson County. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Community HMO SNP-DE (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Community HMO SNP-DE (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Community HMO SNP-DE (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Community HMO SNP-DE (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $310.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Community HMO SNP-DE (HMO D-SNP) plan features an annual prescription drug deductible of $310. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. If you use standard mail order, Tier 1 drugs have a $10 to $30 copay, while Tier 2 drugs carry a $20 to $60 copay. For brand-name and specialty medications, your costs are based on coinsurance. Tier 3 preferred brand and Tier 4 non-preferred drugs require a 25% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs have a 29% coinsurance for a 1-month supply through standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The Humana Community HMO SNP-DE (HMO D-SNP) plan offers comprehensive coverage with no copays for preventive care, home health services, and outpatient services, though outpatient care generally requires a 20% coinsurance. Primary care, specialist visits, dialysis, and medical equipment also feature no copay alongside a 20% coinsurance. For inpatient hospital stays, members pay no coinsurance but are responsible for a copayment of $2,230 per stay for acute care or $2,080 per stay for psychiatric care. This plan includes valuable supplemental benefits, such as dental coverage up to $5,000 annually and a $300 yearly limit for eyewear with no copays or coinsurance. Routine hearing exams require no copay and a 20% coinsurance, while hearing aids and up to 24 one-way transportation trips per year are provided with no copays or coinsurance. Emergency room visits require a $115 copay, which is waived if admitted, while ambulance services carry a $335 copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Community HMO SNP-DE (HMO D-SNP) with no coinsurance, requiring prior authorization and a copayment of $2,230 per stay for acute care or $2,080 per stay for psychiatric care. While unlimited additional days for acute care are covered with no copayment, psychiatric additional days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copays. A 20% coinsurance and prior authorization are required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Community HMO SNP-DE (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation benefits are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services require a $115 copay and no coinsurance.
Primary Care See details
Humana Community HMO SNP-DE (HMO D-SNP) covers primary care, specialist visits, telehealth, mental health, and physical therapy services with no copay and a 20% coinsurance. Podiatry services are not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management, with no copays and no coinsurance. While select supplemental benefits like smoking cessation, memory fitness, and chemotherapy wigs are covered with no copays and no coinsurance, other services such as health education, in-home safety assessments, and weight management are not covered.
Hearing Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers hearing services with no deductible, offering one annual routine hearing exam with no copay and 20% coinsurance, and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids (limited to two every three years) and unlimited OTC hearing aids are covered with no copay or coinsurance, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Humana Community HMO SNP-DE (HMO D-SNP) provides partially covered vision services, including one annual routine eye exam with no copay and 20% coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay or coinsurance up to a $300 yearly limit for one pair of contact lenses or eyeglasses, but individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Community HMO SNP-DE (HMO D-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance. Other preventive and comprehensive dental benefits have no copay and no coinsurance up to a $5,000 annual limit, though fluoride, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers home infusion bundled services with prior authorization, requiring 0% to 20% coinsurance for covered Part B drugs. Under this benefit, insulin carries a $35 copay, other Medicare Part B drugs have no copay, and chemotherapy or radiation drugs are subject to copays and step therapy.
Dialysis Services See details
Dialysis Services are covered under the Humana Community HMO SNP-DE (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Humana Community HMO SNP-DE (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers diagnostic and radiological services with prior authorization, requiring a 20% coinsurance for all covered services. There is no copay for diagnostic procedures, tests, and lab services, while outpatient X-rays require a $50 copay, diagnostic radiological services require a $200 copay, and therapeutic radiological services also require a copay.
Home Health Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Community HMO SNP-DE (HMO D-SNP) does not cover Cardiac Rehabilitation Services in practice, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are all uncovered. Patients will pay no copay but are responsible for a 20% coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Humana Community HMO SNP-DE (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Community HMO SNP-DE (HMO D-SNP) covers other services with no copay and no coinsurance, including acupuncture, over-the-counter items, and meal benefits. This benefit is partially covered because Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered, and prior authorization is required for acupuncture and meals.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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