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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 2026, 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 2026.
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 $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 $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 $9250.00 (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 $9250.00 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:
Sign up for HumanaChoice - Diabetes and Heart (PPO C-SNP)
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Drug Coverage
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan features an annual drug deductible of $450. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies and through preferred mail order, as well as no copay for Tier 6 select care drugs across all fulfillment options. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a one-month supply at standard pharmacies, or no copay for a three-month supply via preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply, though you can save with a $94 copay for a three-month supply when using preferred mail order. Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 27% coinsurance for a one-month supply. These structured costs help you easily plan your prescription expenses depending on your specific medication needs and choice of pharmacy.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers robust coverage with no coinsurance for many essential services, including primary care, home health, and preventive care. Patients benefit from no copay for primary care physician visits, routine eye and hearing exams, and most preventive dental services up to a $500 annual limit. For acute medical needs, specialist visits require a $45 copay, while inpatient hospital stays incur a $375 daily copay for the first seven days followed by no copay for subsequent days. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. Diagnostic lab work and outpatient X-rays are covered with no copay, whereas durable medical equipment and dialysis services require a 20% coinsurance. Additionally, the plan provides convenient extra benefits like over-the-counter hearing aids and chronic illness meals with no copay.
Inpatient Hospital See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers inpatient hospital services with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For covered acute stays, you will pay a $375 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $375 daily copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Patients pay no copay and no coinsurance for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
HumanaChoice - Diabetes and Heart (PPO C-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 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
HumanaChoice - Diabetes and Heart (PPO C-SNP) offers primary care physician services and select telehealth benefits with no copay and no coinsurance. Specialist visits require a $45 copay and therapy services have a $25 copay, both with no coinsurance. Mental health, psychiatric, and podiatry services have copays ranging from $35 to $45 with no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs. Additional preventive services are partially covered, offering a memory fitness benefit with no copay and no coinsurance, but sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers hearing services with no deductibles and no coinsurance, featuring a $45 copay for Medicare-covered exams, no copay for annual routine exams, and no copay for unlimited OTC hearing aids. Prescription hearing aids are partially covered with copays ranging from $699 to $999 for up to two devices annually, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) provides partially covered vision services with no deductible, no coinsurance, and no copays for covered services, subject to prior authorization. This benefit includes one routine eye exam (up to $75 annually) and one pair of select eyeglasses or contact lenses (up to $200 annually), but does not cover other eye exams, standalone eyeglass lenses, standalone eyeglass frames, or upgrades.
Dental Services See details
Dental services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP), featuring a $500 annual limit with no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $45 copay and no coinsurance. This benefit is partially covered, as fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including insulin and chemotherapy, are covered with a coinsurance ranging from no coinsurance to 20%, with insulin carrying a $35 copay.
Dialysis Services See details
Dialysis services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) generally requires a 20% coinsurance and no copay for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers diagnostic services with no coinsurance, featuring no copay for lab services and copays ranging from $0 to $120 for diagnostic procedures and tests. Covered radiological services require prior authorization and include outpatient X-rays with no copay, diagnostic radiology with copays starting at $0, and therapeutic radiology with a minimum $45 copay and 20% coinsurance.
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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no coinsurance and require prior authorization. While some services are covered, cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $30 copay), pulmonary rehabilitation (with a $25 copay), and supervised exercise therapy for PAD (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not needed for admission, additional days beyond the standard 100-day limit are not covered.
Other Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers other services, excluding Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services. Covered options include acupuncture with a $45.00 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* 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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