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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 2025, 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 4 out of 5 stars in 2025.
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 $5.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3300.00 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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, standard generic drugs have a $5 copay at a preferred pharmacy, and preferred brand drugs have 50% coinsurance at either a preferred or standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D-covered drugs. Those who qualify for the low-income subsidy (LIS) may have their premiums reduced. Please check the plan's formulary for specific drugs covered.
Additional Benefits
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay for the first week, with no copay for the remainder of the stay. Outpatient services, including primary care, have copays that vary by service, and emergency services have a copay. This plan also covers preventive services with no copay for many services, and offers coverage for hearing and vision exams, hearing aids, and eyewear, with varying costs. Dental services are also covered with no copay for many services, and a coinsurance for others. Additionally, the plan includes coverage for home health services, skilled nursing facility stays, and offers other services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $195 copay for days 1-7, and no copay for days 8-90, with no coinsurance; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has the same cost structure as Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $150, observation services have a $195 copay, and ambulatory surgical center services have no copay. Individual and group outpatient substance abuse sessions have a copay between $15 and $100.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, with a limit of 24 one-way trips per year. 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 under the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan. Emergency Services has a $140 copay, and Urgently Needed Services has a $65 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay and no coinsurance.
Primary Care See details
Primary Care Physician services are covered with no copay, while Chiropractic Services are covered with no copay, but require prior authorization and a doctor referral. Occupational Therapy Services have a $25 copay, and Physician Specialist Services have a $15 copay. Mental Health Specialty Services, including individual and group sessions, have a $15 copay. Physical Therapy and Speech-Language Pathology Services have a $25 copay. Additional Telehealth Benefits have a copay between $0 and $65, and Opioid Treatment Program Services have a copay between $15 and $100. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services, with no copay for annual physical exams and other services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, and a Fitness Benefit with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, 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, Additional Sessions of Smoking and Tobacco Cessation Counseling, 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
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan covers hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999; however, inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan covers vision services, including eye exams with a copay between $0 and $15, and eyewear with no copay and a combined maximum plan benefit of $300 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan covers dental services, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, restorative services with 30-40% coinsurance and no copay, adjunctive general services with no copay, endodontics with no copay, periodontics with no copay, prosthodontics, removable with 30% coinsurance and no copay, prosthodontics, fixed with 30-40% coinsurance and no copay, and oral and maxillofacial surgery with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a maximum plan benefit of $5000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan. This benefit requires prior authorization and a doctor's referral, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies has a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts has no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services, but require prior authorization and a doctor referral. Diagnostic Procedures/Tests have a copay between $0 and $65, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, while Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan. Prior authorization and a doctor referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan, with a $20 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan covers acupuncture with a $15 copay and a limit of 20 treatments per year, and also covers over-the-counter items up to $840 per year. This 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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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