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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 Emerald Coast. 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) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using standard pharmacies or preferred mail order services for both 1-month and 3-month supplies. However, opting for standard mail order increases your cost to a $10 copay for Tier 1 and a $20 copay for Tier 2 for a 1-month supply. For higher-tier medications, the plan transitions to coinsurance rather than set copays. Tier 3 preferred brand and Tier 4 non-preferred drugs require a 25% coinsurance across standard pharmacies, preferred mail order, and standard mail order options. Specialty medications in Tier 5 carry a 33% coinsurance for a 1-month supply across all available pharmacy and mail order channels.
Additional Benefits
The Humana Dual Integrated (HMO D-SNP) plan offers comprehensive medical coverage, generally featuring no copays and a standard 20% coinsurance for outpatient services, primary care, specialist visits, and dialysis. For inpatient hospital stays, members pay no coinsurance but are responsible for a copay of $2,175 per acute stay or $2,025 per psychiatric stay. Skilled nursing facility care requires no copay for the first 20 days, while emergency room visits carry a $115 copay that is waived if you are admitted within 24 hours. This plan also includes valuable supplemental benefits such as dental, vision, hearing, and transportation services, which largely feature no copays. Members receive up to $2,000 annually for select dental care and a $300 annual allowance for eyewear with no coinsurance. Additionally, routine physicals, home health care, and over-the-counter items are covered with no copay and no coinsurance.
Inpatient Hospital See details
Humana Dual Integrated (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,175 copay per acute stay and a $2,025 copay per psychiatric stay under prior authorization. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Dual Integrated (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization and referrals are required for these services, and no deductible applies to outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Dual Integrated (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
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, subject to prior authorization. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Dual Integrated (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a 20% coinsurance (up to $40) and no copay, 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, therapy, psychiatric, and telehealth services with no copay and a 20% coinsurance. Routine chiropractic and routine podiatry services are also covered for up to 12 visits per year with no copay and a 20% coinsurance, though other non-routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Dual Integrated (HMO D-SNP) with no copays and no coinsurance for covered benefits like annual physical exams, glaucoma screenings, and kidney disease education. However, several additional services are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Humana Dual Integrated (HMO D-SNP) hearing services are partially covered, as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. Covered services feature no copay and no coinsurance for Medicare-covered exams, fitting evaluations, OTC devices, and prescription hearing aids up to $1,000 per ear annually, while routine exams require a 20% coinsurance and no copay.
Vision Services See details
Humana Dual Integrated (HMO D-SNP) covers vision services with no deductible and no copays, featuring one routine eye exam per year with a 20% coinsurance and up to $300 annually for contact lenses and eyeglasses with no coinsurance. Other eye exam services, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Dual Integrated (HMO D-SNP) dental services are partially covered, featuring Medicare-covered dental care with no copay and a 20% coinsurance, and other dental services up to a $2,000 annual limit with no copay and no coinsurance. While preventive and comprehensive services like cleanings, exams, and restorative work are included, fluoride treatments, implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Dual Integrated (HMO D-SNP) covers home infusion bundled services with prior authorization, requiring a 0% to 20% coinsurance and applicable copays for Part B chemotherapy and radiation drugs. Covered Part B insulin requires a $35 copay and 0% to 20% coinsurance, while other Part B drugs have no copay and a 0% to 20% coinsurance.
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 receive these covered services.
Medical Equipment See details
Humana Dual Integrated (HMO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance, subject to specified manufacturer limitations.
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. There is no copay for lab services or radiological services, while diagnostic procedures and tests require a copayment.
Home Health Services See details
Humana Dual Integrated (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Humana Dual Integrated (HMO D-SNP), as all individual sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Dual Integrated (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by Humana Dual Integrated (HMO D-SNP) include acupuncture, over-the-counter items, and meal benefits for qualifying medical conditions, all of which feature no copay and no coinsurance. Prior authorization is required for the meal benefit and acupuncture, which is limited to 25 treatments per year.
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