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Humana PathWays Dual Care (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana PathWays Dual Care (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana PathWays Dual Care (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Humana PathWays Dual Care (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Indiana. The overall rating for this plan is not yet available for 2026.
It's important to know that Humana PathWays Dual Care (HMO-POS 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 PathWays Dual Care (HMO-POS 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 PathWays Dual Care (HMO-POS 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 PathWays Dual Care (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.90. 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 PathWays Dual Care (HMO-POS D-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for one-month and three-month supplies at standard pharmacies and through preferred mail order. If you utilize standard mail order for these generics, copays range from $10 to $30 for Tier 1 and $20 to $60 for Tier 2 depending on the supply. For higher-tier medications, including Tier 3 preferred brands and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for both one-month and three-month supplies across standard pharmacies and mail-order services. Tier 5 specialty tier drugs also require a 25% coinsurance for a one-month supply. This clear cost-sharing structure helps you easily plan for your prescription drug expenses.
Additional Benefits
The Humana PathWays Dual Care (HMO-POS D-SNP) plan provides coverage for essential medical services, featuring no copay and a 20% coinsurance for primary care, specialist visits, and outpatient hospital services. Inpatient acute hospital stays require a $2,230 copay per stay, while emergency room visits carry a $115 copay that is waived upon admission. Skilled nursing facility care is also covered with no coinsurance, featuring no copay for the first 20 days and a $218 daily copay for days 21 through 100. For additional wellness needs, this plan covers routine dental services up to a $2,500 annual limit and vision wear up to a $350 limit, both with no copays. Hearing exams, hearing aids, and home health services are also covered with no copays and no deductibles. Furthermore, members can access transportation to approved medical locations, over-the-counter items, and acupuncture with no copay and no coinsurance.
Inpatient Hospital See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers inpatient acute hospital stays with a $2,230 copay per stay and psychiatric stays with a $2,080 copay per stay, both with no coinsurance and requiring prior authorization. While unlimited additional days for acute care are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for these covered services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent, and transportation services require a $115 copay and no coinsurance.
Primary Care See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and a 20% coinsurance. Routine chiropractic and podiatry services are covered for up to 12 visits per year, though other chiropractic services are not covered.
Preventive Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, glaucoma screenings, and memory fitness. However, sub-services such as 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 benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers hearing services with no deductible, offering routine exams with no copay and 20% coinsurance, and fitting evaluations and OTC hearing aids 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, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) offers partially covered vision services, providing one routine eye exam and eyewear (contact lenses or eyeglasses) per year with no copay and a 20% coinsurance, up to a $350 annual limit. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
Dental services are partially covered by Humana PathWays Dual Care (HMO-POS D-SNP), featuring Medicare-covered dental care with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $2,500 annual limit. Excluded services that are not covered include fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers Home Infusion bundled Services with prior authorization, requiring 0% to 20% coinsurance for Part B chemotherapy, radiation, and other drugs, with no copay for other Part B drugs. Covered Part B insulin has a $35 copay and 0% to 20% coinsurance, and step therapy may apply.
Dialysis Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers dialysis services with no copay and a 20% coinsurance, subject to prior authorization requirements.
Medical Equipment See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment with 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana PathWays Dual Care (HMO-POS D-SNP) with prior authorization required. Diagnostic tests, procedures, and lab services feature no copay and a 20% coinsurance, while outpatient X-rays require a $50 copay and 20% coinsurance. Diagnostic and therapeutic radiological services carry a 20% coinsurance, with diagnostic radiological services also requiring a $200 copay.
Home Health Services See details
Home Health Services are covered by Humana PathWays Dual Care (HMO-POS D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana PathWays Dual Care (HMO-POS D-SNP) covers some Cardiac Rehabilitation Services with no copay, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana PathWays Dual Care (HMO-POS D-SNP) with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a daily copay of $218 for days 21 through 100, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
Other services are covered by Humana PathWays Dual Care (HMO-POS D-SNP), including acupuncture limited to 25 treatments per year, over-the-counter (OTC) items, and a meal benefit for chronic or medical conditions. These benefits feature no copay and no coinsurance, though prior authorization is required for acupuncture and meals.
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