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Humana Dual Fully Integrated H2875-003 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Fully Integrated H2875-003 (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 Fully Integrated H2875-003 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Southwest Virginia. The overall rating for this plan is not yet available for 2025.
It's important to know that Humana Dual Fully Integrated H2875-003 (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 Fully Integrated H2875-003 (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 Fully Integrated H2875-003 (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 Fully Integrated H2875-003 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.70. 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 $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 Dual Fully Integrated H2875-003 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs depending on the drug tier. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), you may have a reduced premium.
Additional Benefits
The Humana Dual Fully Integrated H2875-003 (HMO D-SNP) plan offers a wide range of benefits with varying costs. This plan covers inpatient hospital stays with copays, and outpatient services, including primary care, with coinsurance. Emergency services, hearing, vision, and dental services are also covered. Additional benefits include home health services with no copay, and coverage for medical equipment, diagnostic services, and skilled nursing facilities. The plan also includes coverage for ambulance services and transportation, as well as other services like acupuncture, an over-the-counter benefit, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, which require prior authorization. For Inpatient Hospital-Acute, the copay is $2,185 per admission or stay, and for Inpatient Hospital Psychiatric, the copay is $2,036 per admission or stay; Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a 20% coinsurance, while ambulatory surgical center services and outpatient substance abuse services have a coinsurance of at least 20%. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance, and requires prior authorization.
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, with no coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Dual Fully Integrated H2875-003 (HMO D-SNP) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician services with a 20% coinsurance, Chiropractic Services with 20% coinsurance and a copay for other services, Occupational Therapy Services with 20% coinsurance, Physician Specialist Services with 20% coinsurance, Mental Health Specialty Services with 20% coinsurance, Podiatry Services with 20% coinsurance and a copay for Medicare-covered services, Other Health Care Professional services with 20% coinsurance, Psychiatric Services with 20% coinsurance, Physical Therapy and Speech-Language Pathology Services with 20% coinsurance, Additional Telehealth Benefits with 20% coinsurance and no copay, and Opioid Treatment Program Services with 20% coinsurance. Routine Chiropractic Care has a $0 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services, including fitness and in-home support services. The plan also covers kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, 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
Hearing services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% for routine exams and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids, and prescription hearing aids have no copay for prescription hearing aids (all types). OTC hearing aids are not covered, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Humana Dual Fully Integrated H2875-003 (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance. Eyewear is covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Other services such as fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare dental services have a 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Insulin has a $35 copay and a coinsurance between 0-20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%, and Other Medicare Part B Drugs have no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Dual Fully Integrated H2875-003 (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a coinsurance of at most 20%, and Lab Services have a coinsurance of at most 20% with no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $200, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Dual Fully Integrated H2875-003 (HMO D-SNP) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and coinsurance applies.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Dual Fully Integrated H2875-003 (HMO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a 20% coinsurance and requires prior authorization, while the OTC benefit has a maximum coverage amount of $2700.00 per year. The meal benefit has no copay and requires prior authorization.
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