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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 Select Counties in OK. 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 $2.00. 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 $200.00 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 $9700.00 (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 $9700.00 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 $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, for a preferred generic drug, you will pay a $9 copay at a preferred pharmacy or preferred mail order, and a $20 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers comprehensive coverage for a wide range of healthcare needs. This plan includes coverage for inpatient and outpatient services, with varying copays depending on the service. Additionally, the plan provides benefits for primary care, preventive services, hearing, vision, dental, and home health services, often with no copay or low copays. This plan also offers coverage for emergency services, ambulance services, and skilled nursing facilities, with some services requiring prior authorization. Other benefits include coverage for medical equipment, diagnostic and radiological services, and services like acupuncture and over-the-counter items. Overall, the plan aims to provide a well-rounded healthcare package with a focus on managing diabetes and heart conditions.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For inpatient hospital acute care, you pay a $300 copay for days 1-6, and no copay for days 7-90, with no coinsurance. For inpatient hospital psychiatric care, you pay a $300 copay for days 1-6, and no copay for days 7-90, with no coinsurance. Additional days for inpatient hospital acute care have no copay, and no coinsurance. Non-Medicare-covered stays and upgrades for inpatient hospital acute care, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $270, and observation services with a $300 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have copays between $25 and $100 for individual and group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan, and requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan. Both ground and air ambulance services have a $315 copay, with no coinsurance, and require prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 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 $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, and mental health specialty services with a $25 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a copay between $25 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include annual physical exams with no copay, while additional preventive services are covered and may have a copay. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit have no copay.
Hearing Services See details
Hearing Services includes hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $199 and $799, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with a combined maximum of $250 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum benefit for both in-network and out-of-network services. You will pay a $25 copay for Medicare Dental Services and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
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), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $100, Lab Services with no copay, and Outpatient X-Ray Services with no copay. Therapeutic Radiological Services have a copay of at most $40 and coinsurance of at least 20%, while Diagnostic Radiological Services have a copay of at most $325.
Home Health Services See details
Home Health Services are covered by the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a copay of $10 for days 1-20 and $214 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
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan covers acupuncture with a $25 copay, OTC items up to $540 per year, and a meal benefit with no copay. Several other services, including Dual Eligible SNPs with Highly Integrated Services, are not covered.
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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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