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Humana Dual Select H2875-005 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H2875-005 (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 Select H2875-005 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Dual Select H2875-005 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2026 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 Select H2875-005 (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 Select H2875-005 (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 Select H2875-005 (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 Select H2875-005 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.30. 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 Select H2875-005 (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. If you choose standard mail order, Tier 1 drugs carry a $10 copay for a 1-month supply and a $30 copay for a 3-month supply, while Tier 2 drugs cost a $20 copay for a 1-month supply and a $60 copay for a 3-month supply. For higher-tier medications, including Tier 3 preferred brand, Tier 4 non-preferred drug, and Tier 5 specialty tier, you will pay a 25% coinsurance. This 25% coinsurance rate remains consistent across standard pharmacies, preferred mail order, and standard mail order channels. Understanding these copayment and coinsurance details helps you estimate your annual out-of-pocket healthcare costs with this Humana HMO D-SNP plan.
Additional Benefits
The Humana Dual Select H2875-005 (HMO D-SNP) offers comprehensive coverage with no copay for primary care visits, preventive services, home health care, and routine vision and hearing exams. For specialized care, members face predictable costs such as a $25 copay for specialist visits and Medicare-covered dental services, alongside a 20% coinsurance for durable medical equipment and dialysis. Inpatient hospital stays require a $225 daily copay for the first five days with no copay thereafter, while emergency room visits carry a $115 copay that is waived if admitted. This plan also features valuable everyday benefits, including up to 60 one-way trips to plan-approved health locations and routine dental care with no copay up to a $5,000 annual limit. Additionally, members can access a $450 annual eyewear allowance and receive covered over-the-counter items and prescription hearing aids with no copay.
Inpatient Hospital See details
Humana Dual Select H2875-005 (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $225 daily copay for days 1 through 5 and no copay for days 6 and beyond. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Dual Select H2875-005 (HMO D-SNP) with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Medicare-covered outpatient hospital services have a copay ranging from $0 to $250, observation services require a $250 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Humana Dual Select H2875-005 (HMO D-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Humana Dual Select H2875-005 (HMO D-SNP) covers emergency ground and air ambulance services with a $335 copay and no coinsurance. The plan also provides partial transportation coverage, offering up to 60 one-way trips per year 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
Humana Dual Select H2875-005 (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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Dual Select H2875-005 (HMO D-SNP) covers primary care physician visits with no copay and no coinsurance, and specialist visits for a $25 copay and no coinsurance. Therapy and routine chiropractic services require a 20% coinsurance and no copay, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Humana Dual Select H2875-005 (HMO D-SNP) covers preventive services, annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. Additional preventive services are partially covered with no copay or coinsurance for fitness and in-home support, but do not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, or counseling.
Hearing Services See details
Humana Dual Select H2875-005 (HMO D-SNP) covers hearing exams with a $25 copay and no coinsurance for Medicare-covered visits, while routine exams, fitting evaluations, and OTC hearing aids are available with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two devices every three years, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Humana Dual Select H2875-005 (HMO D-SNP) with no deductibles, no copays, and no coinsurance for one routine eye exam per year and up to $450 annually for contact lenses and eyeglasses (lenses and frames). Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Dual Select H2875-005 (HMO D-SNP) partially covers dental services up to a $5,000 annual maximum, offering Medicare-covered dental services for a $25 copay and no coinsurance, and other covered dental services with no copay and no coinsurance. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Dual Select H2875-005 (HMO D-SNP) covers Home Infusion bundled Services with prior authorization and step therapy, featuring 0% to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered insulin has a $35 copay and 0% to 20% coinsurance, while other Part B drugs require no copay.
Dialysis Services See details
Dialysis services are covered by Humana Dual Select H2875-005 (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Dual Select H2875-005 (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic supplies, with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, and prior authorization is required for most of these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Dual Select H2875-005 (HMO D-SNP) with prior authorization, featuring a 20% coinsurance across all services. Outpatient X-rays, lab services, and diagnostic radiology have no copay, while diagnostic procedures range from no copay up to $40, and therapeutic radiology requires a minimum $25 copay. If you receive multiple services at the same location on the same day, only the maximum copay applies.
Home Health Services See details
Humana Dual Select H2875-005 (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Dual Select H2875-005 (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay, subject to prior authorization. However, specific services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Dual Select H2875-005 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Dual Select H2875-005 (HMO D-SNP) provides coverage for select other services, including acupuncture with a $25 copay and no coinsurance for up to 20 treatments per year with prior authorization. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, though some other services in this category are not covered.
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