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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 2025, 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 out of 5 stars in 2025.
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 $4.20. 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 $590.00 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 $9350.00 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 has a $590 deductible for prescription drugs. After you meet the deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), with a cost of $4.20 for LIS-eligible members. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Community HMO SNP-DE (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay per admission, while outpatient services and partial hospitalization have coinsurance. Emergency services have a copay, and ambulance services have a copay, while transportation to health-related locations is covered with no copay for a limited number of trips. Preventive services, eye exams, and hearing exams are covered with no copay or have a coinsurance. The plan also covers dental services with coinsurance and an annual maximum. Prescription hearing aids and eyewear are partially covered with no copay, while other services like home health services and skilled nursing facilities have copays. Additionally, the plan offers acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $2185 per admission or stay, and additional days are unlimited with no copay. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $2036 per admission or stay, and additional days are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance between 20% and 20%. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $315 copay, while transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year via taxi, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Community HMO SNP-DE (HMO D-SNP) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a 20% coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Community HMO SNP-DE (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, additional telehealth benefits, and opioid treatment program services have a 20% coinsurance. Occupational therapy services, physical therapy and speech-language pathology services have a 20% coinsurance. Additional telehealth benefits have no copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services, including wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams and no copay. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids are partially covered; all types of prescription hearing aids have no copay, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Community HMO SNP-DE (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with no copay and a combined maximum of $300 per year. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, and a $5,000 annual maximum for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but have visit limits. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is no copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the Humana Community HMO SNP-DE (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment (DME) has a 20% coinsurance. Diabetic supplies have a 20% coinsurance and no copay, while diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Community HMO SNP-DE (HMO D-SNP) plan. Diagnostic Procedures/Tests have at most 20% coinsurance and no copay, while Lab Services have at most 20% coinsurance and no copay. Diagnostic Radiological Services have at most 20% coinsurance and a copay of at most $325.00, Therapeutic Radiological Services have at most 20% coinsurance, and Outpatient X-Ray Services have at most 20% coinsurance and a $50 copay.
Home Health Services See details
Home Health Services are covered by the Humana Community HMO SNP-DE (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Community HMO SNP-DE (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Community HMO SNP-DE (HMO D-SNP) plan covers acupuncture with no copay and up to 12 treatments per year, and also covers over-the-counter items, including nicotine replacement therapy and Naloxone, up to $2100 per year. Additionally, the plan covers a meal benefit with no copay. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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