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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 Central MI, Detroit, Grand Rapids, S. MI. 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.
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 $300.00 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 $6550.00 (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 $6550.00 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 features an annual drug deductible of $300. For Tier 1 preferred generics and Tier 6 select care drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications cost as little as a $10 copay for a 1-month supply, with no copay required for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply across most pharmacy and mail order channels. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs costing 47% coinsurance and Tier 5 specialty drugs requiring 29% coinsurance. Utilizing preferred mail order services often yields the lowest out-of-pocket costs for your prescriptions under this plan.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers comprehensive medical coverage with no copays and no coinsurance for primary care visits, preventive screenings, and home health services. Specialist visits require a $40 copay, and emergency room care is available for a $130 copay, both with no coinsurance. For inpatient hospital stays, members pay a $530 daily copay for the first five days, with no copay or coinsurance required for subsequent days. This plan also includes valuable supplemental benefits, such as routine dental and vision care with no copays, featuring up to a $2,000 annual maximum for dental services. Additionally, members can access routine hearing exams, over-the-counter hearing aids, and up to 40 routine one-way transportation trips per year with no copay. For specialized needs like dialysis and durable medical equipment, there is no copay, but a 20% coinsurance applies.
Inpatient Hospital See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $530 daily copay for days 1 to 5 of acute stays and a $650 daily copay for days 1 to 3 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no coinsurance, featuring a $0 to $530 copay for outpatient hospital services and a $530 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $35 copay with 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. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers ambulance services with a $335 copay and no coinsurance for both ground and air transportation. Routine transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) for a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Additional benefits like physical therapy, mental health, and telehealth are covered with copays ranging from $0 to $50 and no coinsurance, although podiatry and routine chiropractic care are not covered.
Preventive Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness benefit with no copay and no coinsurance, while other sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services offered by HumanaChoice - Diabetes and Heart (PPO C-SNP) include Medicare-covered exams for a $40 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear types are not covered. Over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers vision services with no coinsurance and no deductibles, though prior authorization is required. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are available with no copay up to annual limits, while other eye exams carry a copay of up to $40. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice - Diabetes and Heart (PPO C-SNP), which offers up to a $2,000 annual maximum benefit for both in-network and out-of-network care. Medicare dental services require a $40 copay and no coinsurance, while most preventive and comprehensive services feature no copay and no coinsurance, except for restorative services (no copay and 30% to 40% coinsurance) and removable prosthodontics (no copay and 30% coinsurance). Fluoride treatments, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while covered insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with a 20% coinsurance and no copay. Prior authorization is required for most of these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic services have no coinsurance, featuring no copay for lab services and a $0 to $100 copay for procedures, while radiological services feature no copay for X-rays and diagnostic radiology, and a $35 copay with 20% coinsurance for therapeutic services.
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. This benefit ensures eligible members can access necessary in-home medical care at no out-of-pocket cost.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no coinsurance and prior authorization required, but only some services are covered in practice. Specifically, Cardiac Rehabilitation and Intensive Cardiac Rehabilitation (both with no copay), Pulmonary Rehabilitation (with a $15 copay), and SET for PAD services (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no coinsurance, requiring a $10.00 daily copay for days 1 to 20 and a $218.00 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required before admission, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) offers partial coverage for other services, excluding Dual Eligible SNPs and other unspecified services. Covered benefits include acupuncture for a $40 copay and no coinsurance, as well as 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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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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