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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 2026, 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 2026.
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 $23.10. 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 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 $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 Fully Integrated H2875-003 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when utilizing standard pharmacies or preferred mail order services for 1-month and 3-month supplies. If you choose standard mail order, generic drug copays range from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For brand-name and specialty medications, the plan transitions to a percentage-based cost-sharing model. Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs all require a 25% coinsurance across standard pharmacies, preferred mail order, and standard mail order channels. This straightforward cost structure helps you accurately budget for your monthly prescription expenses under this Humana Medicare plan.
Additional Benefits
The Humana Dual Fully Integrated H2875-003 (HMO D-SNP) plan offers comprehensive medical coverage with no copay and a 20% coinsurance for primary care, specialist visits, outpatient services, and diagnostic tests. For inpatient hospital stays, members pay a $2,230 copay per acute stay or a $2,080 copay per psychiatric stay, while skilled nursing facility care features no copay for the first 20 days. Emergency room visits require a $115 copay, which is waived if you are admitted, and ambulance services carry a $335 copay. Preventive care and home health services are fully covered with no copay and no coinsurance. Additionally, the plan provides generous routine benefits, including up to $5,000 in dental coverage, a $450 annual eyewear allowance, and hearing aid coverage with no copay or coinsurance. Members also benefit from covered over-the-counter items and meals for chronic illnesses with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Dual Fully Integrated H2875-003 (HMO D-SNP) with no coinsurance, though prior authorization is required. Acute inpatient stays require a $2,230 copay per stay with unlimited additional days at no copay, while psychiatric stays require a $2,080 copay per stay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance and prior authorization are required for most services. This 20% coinsurance applies to outpatient hospital and observation services, ambulatory surgical center visits, outpatient substance abuse sessions, and outpatient blood services.
Partial Hospitalization See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required before you can receive this benefit.
Ambulance and Transportation Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. While transportation services are technically covered, trips to plan-approved or any health-related locations are not covered by the plan.
Emergency Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) 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 Fully Integrated H2875-003 (HMO D-SNP) covers primary care, specialist, mental health, therapy, and telehealth services with no copay and 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.
Preventive Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes training, rectal exams, and post-welcome visit EKGs. However, the benefit is partially covered as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Dual Fully Integrated H2875-003 (HMO D-SNP) with no deductible, offering fitting evaluations, OTC hearing aids, and up to two prescription hearing aids every three years with no copay or coinsurance. Routine hearing exams are covered once per year with a 20% coinsurance and no copay, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) partially covers vision services with no deductibles, offering one annual routine eye exam with no copay and a 20% coinsurance. The plan also covers eyewear with no copay and no coinsurance up to a $450 yearly limit for one pair of eyeglasses or contact lenses, though separate lenses, frames, upgrades, and other eye exams are not covered.
Dental Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) offers partially covered dental services up to a $5,000 annual maximum, featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers home infusion bundled services, which require prior authorization and step therapy. Covered Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, while other covered Part B drugs carry 0% to 20% coinsurance and no copay for non-chemotherapy drugs.
Dialysis Services See details
Dialysis services are covered by the Humana Dual Fully Integrated H2875-003 (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic supplies, with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are covered with no copay, and prior authorization is required for most of these benefits.
Diagnostic and Radiological Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Humana Dual Fully Integrated H2875-003 (HMO D-SNP) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Dual Fully Integrated H2875-003 (HMO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20, and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Dual Fully Integrated H2875-003 (HMO D-SNP) covers other services including acupuncture with no copay and 20% coinsurance, alongside over-the-counter items and meal benefits for chronic illnesses with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while highly integrated services are not covered.
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