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Humana Community HMO Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Community HMO Diabetes and Heart (HMO C-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 Diabetes and Heart (HMO C-SNP) in 2026, please refer to our full plan details page.
Humana Community HMO Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Cook, DuPage and Will counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Community HMO Diabetes and Heart (HMO C-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 Diabetes and Heart (HMO C-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 Diabetes and Heart (HMO C-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 Diabetes and Heart (HMO C-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. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $615.00 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 $2950.00 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 Diabetes and Heart (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 6 select care drugs, members enjoy no copay when using standard pharmacies or preferred mail order options. Tier 2 generic medications are also highly affordable, costing a $5 copay for a one-month supply or no copay for a three-month fill through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard pharmacies and through mail order. For higher-tier medications, members will pay a 50% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan offers affordable coverage with many essential services featuring no copays or coinsurance. You will pay no copay for primary care physician visits, routine lab services, and preventive care, while specialist visits require a $15 copay. Inpatient hospital stays require a $195 daily copay for days 1 through 7, and emergency care is covered with a $150 copay that is waived upon admission. Additional benefits include up to a $5,000 annual limit for dental care and a $350 annual limit for vision services, both with no copay or coinsurance for routine care. Routine hearing exams and over-the-counter hearing aids also feature no copay, while diabetic supplies and home health services are fully covered. For specialized care, dialysis services and durable medical equipment require a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $195 daily copay for days 1 through 7 and no copay for days 8 through 90. Additional acute hospital days are unlimited with no copay, though additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $200 copay for outpatient hospital services and a $195 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are fully covered with no copays and no coinsurance, while outpatient substance abuse sessions require a $15 to $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation benefits are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, and telehealth services with a $0 to $65 copay and no coinsurance. Specialist visits require a $15 copay, therapy services require a $25 copay, and psychiatric services require a $20 copay, all with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copays and no coinsurance. Additional preventive services are partially covered, offering a memory fitness benefit with no copay, while excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) offers partially covered hearing services, featuring Medicare-covered exams for a $15 copay and no coinsurance, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay or coinsurance. Prescription hearing aids require a copay of $699 to $999 and no coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) with no deductible, no coinsurance, and no copay for routine eye exams, contact lenses, and eyeglasses, up to a $350 annual limit. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan, which provides up to a $5,000 annual limit with no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $15 copay and no coinsurance, prosthodontics require a 30% coinsurance and no copay, and fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, such as chemotherapy and insulin, are subject to a 0% to 20% coinsurance, with insulin specifically requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Humana Community HMO Diabetes and Heart (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the Humana Community HMO Diabetes and Heart (HMO C-SNP), with prior authorization required. Durable medical equipment and prosthetics are subject to a 20% coinsurance and no copay, while diabetic supplies from specified manufacturers and therapeutic shoes are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan, though referrals and prior authorizations are required. Diagnostic procedures carry a $0 to $65 copay with no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) covers some Cardiac Rehabilitation Services with no coinsurance and copays ranging from no copay to $15, though prior authorization and referrals are required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Humana Community HMO Diabetes and Heart (HMO C-SNP) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, a three-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Community HMO Diabetes and Heart (HMO C-SNP) partially covers other services, providing acupuncture for a $15 copay and no coinsurance, and both meal benefits and over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while Dual Eligible SNPs with Highly Integrated Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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