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HumanaChoice - Diabetes and Heart (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice - Diabetes and Heart (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice - Diabetes and Heart (PPO C-SNP) in 2025, please refer to our full plan details page.
HumanaChoice - Diabetes and Heart (PPO C-SNP) is a PPO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice - Diabetes and Heart (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HumanaChoice - Diabetes and Heart (PPO 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 HumanaChoice - Diabetes and Heart (PPO 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 HumanaChoice - Diabetes and Heart (PPO 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 $3.00. 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 $450.00 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 combined Maximum Out-Of-Pocket cost of $9350.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9350.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 HumanaChoice - Diabetes and Heart (PPO C-SNP) plan has a $450 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy. For standard generic drugs, you'll pay a $47 copay. The plan also has a catastrophic coverage phase, where you pay nothing for Part D covered drugs after your yearly out-of-pocket drug costs reach $2000.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers a wide range of benefits with varying costs. This plan includes no copays for primary care, preventive services like annual physical exams, and many dental services like oral exams and cleanings. You can also expect no copays for outpatient blood services and home health services. The plan has copays for services such as inpatient hospital stays, outpatient services, specialist visits, and hearing exams. Emergency services and ambulance services are covered with a copay, and other services like home infusion drugs and dialysis services have coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care. For acute care, you'll pay a $399 copay for days 1-6, and no copay for days 7-90, with additional days 91-999 having no copay; however, non-Medicare covered stays and upgrades are not covered.
Psychiatric care also has a $399 copay for days 1-5, and no copay for days 6-90, but additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $450, observation services with a $399 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a copay between $45 and $100 for individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP), with a $315 copay for both ground and air ambulance services and no coinsurance. 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. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all services have no coinsurance.
Primary Care See details
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. It also covers physician specialist services with a $45 copay, mental health and psychiatric services with a $45 copay, and podiatry services with a $45 copay for routine foot care. Additionally, the plan covers physical therapy and speech-language pathology services with a $25 copay, telehealth benefits with a $0-$45 copay, and opioid treatment program services with a $45-$100 copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional services like Health Education, In-Home Safety Assessment, and other services are not covered, but Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $45 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $45, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice - Diabetes and Heart (PPO 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, and other preventive dental services with no copay. This plan does not cover fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan, but require prior authorization. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment includes Diabetic Supplies with a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $120, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $325, and Therapeutic Radiological Services have a copay of at most $45 and coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan, but specific services like Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $45 copay per visit, up to 20 treatments per year, and the OTC benefit has a maximum coverage amount of $540 per year. The meal benefit has no copay. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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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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