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Humana Dual Integrated (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Integrated (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 Dual Integrated (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Dual Integrated (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Central and North Florida. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Dual Integrated (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 Dual Integrated (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 Dual Integrated (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 Dual Integrated (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 no drug deductible. Your prescription medication coverage will start immediately.
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 Dual Integrated (HMO D-SNP) prescription drug plan features a $0 drug deductible, allowing your coverage to begin immediately. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay for 1-month or 3-month supplies filled at standard pharmacies or through preferred mail order. If you use standard mail order for these generics, you will pay a copay of $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. Tier 3 preferred brand and Tier 4 non-preferred drugs require a 25% coinsurance for both 1-month and 3-month supplies at standard pharmacies and mail order services. Tier 5 specialty drugs carry a 33% coinsurance for a 1-month supply across all available pharmacy and mail order channels. This Medicare plan structure provides clear cost savings on generic medications while utilizing coinsurance for brand-name and specialty prescriptions.
Additional Benefits
The Humana Dual Integrated (HMO D-SNP) offers comprehensive medical coverage, featuring no copays and a standard 20% coinsurance for outpatient care, doctor visits, and dialysis. Inpatient hospital stays require a set copay per admission with no coinsurance, while emergency room visits carry a $115 copay that is waived upon admission. Preventive care, home health services, and routine physicals are fully covered with no copays or coinsurance. This plan also provides valuable supplemental benefits, including dental coverage up to a $5,000 annual limit and vision hardware up to $300 yearly with no copays or coinsurance. Additionally, members receive a $1,000 annual allowance per ear for hearing aids, unlimited plan-approved transportation, and acupuncture and meal benefits at no cost. Covered Part B insulin is capped at a $35 copay, while diabetic equipment and select medical supplies feature no copays.
Inpatient Hospital See details
Humana Dual Integrated (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $2,230 copay per admission with unlimited additional days at no copay, and psychiatric stays require a $2,080 copay per admission, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Humana Dual Integrated (HMO D-SNP) plan are covered with no copay and a 20% coinsurance, which applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for these covered services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Dual Integrated (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Dual Integrated (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for unlimited one-way trips to plan-approved locations, but transportation to any non-approved health-related location is not covered.
Emergency Services See details
Humana Dual Integrated (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay and a 20% coinsurance up to $40, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Dual Integrated (HMO D-SNP) covers primary care, specialist, mental health, therapy, and telehealth services with no copay and a 20% coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance while other chiropractic services are not covered, and routine podiatry is covered for up to 12 visits per year with no copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Humana Dual Integrated (HMO D-SNP) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and fitness benefits. Non-covered services under this plan include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access, and home safety modifications.
Hearing Services See details
Humana Dual Integrated (HMO D-SNP) hearing services include annual routine exams with a 20% coinsurance and no copay, plus annual fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to $1,000 per ear annually with no copay or coinsurance, though inner ear, outer ear, and over-the-ear types are not covered. Over-the-counter (OTC) hearing aids are also covered with no copay or coinsurance.
Vision Services See details
Humana Dual Integrated (HMO D-SNP) offers partially covered vision services, featuring one annual routine eye exam with no copay and a 20% coinsurance, and contact lenses or eyeglasses (lenses and frames) with no copay, no coinsurance, up to a $300 yearly limit. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered, and prior authorization and referrals are required.
Dental Services See details
Humana Dual Integrated (HMO D-SNP) dental services are partially covered, featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental services up to a $5,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Dual Integrated (HMO D-SNP) subject to prior authorization and step therapy, requiring a 0% to 20% coinsurance for Part B chemotherapy, radiation, and other drugs. Covered Part B insulin has a $35 copay and 0% to 20% coinsurance, while other Part B drugs have no copay.
Dialysis Services See details
Humana Dual Integrated (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these services.
Medical Equipment See details
Humana Dual Integrated (HMO D-SNP) covers medical equipment with no copays across all categories, though a 20% coinsurance applies to durable medical equipment, prosthetics, and medical supplies. Diabetic equipment and therapeutic shoes are covered with no copay and no coinsurance, although prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Humana Dual Integrated (HMO D-SNP) covers diagnostic and radiological services with a minimum 20% coinsurance, requiring prior authorization and referrals for all services. Diagnostic procedures and tests require a copay, while lab services, X-rays, and radiological services have no copay.
Home Health Services See details
Home health services are covered under the Humana Dual Integrated (HMO D-SNP) plan with no copay and no coinsurance. Members will need to obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Humana Dual Integrated (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, but in practice, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require 20% coinsurance. Prior authorization and referrals are also required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Dual Integrated (HMO D-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Dual Integrated (HMO D-SNP) provides coverage for acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance, though prior authorization is required for acupuncture and meals. Acupuncture is limited to 25 treatments per year, and other unspecified services or highly integrated dual-eligible SNP services are not covered.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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