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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 Select Counties in IL. 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 $15.00. 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 $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 combined Maximum Out-Of-Pocket cost of $13900.00 (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 $13900.00 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) prescription drug plan has an annual drug deductible of $615. You will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using standard pharmacies or preferred mail order. However, standard mail order for these generic tiers requires a copay, ranging from $10 to $30 for Tier 1 and $20 to $60 for Tier 2 depending on the supply. For Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance across standard pharmacies and mail order services. Tier 6 select care drugs are highly affordable, requiring no copay for both 1-month and 3-month supplies at all standard pharmacies and mail order options. This plan provides excellent savings on generic and select care medications while utilizing coinsurance for brand and specialty prescriptions.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers comprehensive medical coverage, featuring no copay and a 20% coinsurance for primary care, specialist visits, outpatient services, and diagnostic tests. Inpatient hospital stays require a copay of $2,230 per stay with no coinsurance, while skilled nursing facility care is available with no copay for the first 20 days. Emergency care is covered with a $115 copay, which is waived if you are admitted, and ground ambulance services require a $335 copay. This plan also includes valuable supplemental benefits, such as dental care with a $3,000 annual limit and no copay for routine cleanings, alongside vision and hearing benefits that feature no deductibles. Additionally, members benefit from home health services, over-the-counter items, and chronic illness meals with no copay or coinsurance, plus up to 24 one-way transportation trips per year to plan-approved locations.
Inpatient Hospital See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers inpatient hospital services with prior authorization required and no coinsurance. Medicare-covered acute stays require a $2,230 copay per stay with unlimited additional days at no copay, while psychiatric stays require a $2,080 copay per stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient substance abuse services with no copay and a 20% coinsurance. Outpatient blood services are also covered with no copay and no coinsurance, while observation services require a copayment and a 20% coinsurance.
Partial Hospitalization See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any other health-related location 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 are covered with a 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent, and transportation services are available with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) primary care benefits feature no copay and a 20% coinsurance for most covered services, including primary care, specialist, therapy, and mental health visits. Podiatry services are not covered, and while some chiropractic services are covered, routine and other chiropractic services are excluded.
Preventive Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) provides partially covered preventive services with no copay and no coinsurance for covered care like annual physical exams, kidney disease education, and glaucoma screenings. However, several additional preventive services are not covered, including fitness benefits, health education, nutritional/dietary benefits, and in-home support.
Hearing Services See details
Hearing services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no deductible. Routine hearing exams have no copay and 20% coinsurance, while fitting evaluations and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $0 to $599, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) provides partially covered vision services with no deductibles, offering one routine eye exam and either one pair of eyeglasses or contact lenses yearly with no copays. A 20% coinsurance applies to routine exams and contact lenses, with annual maximums of $40 for exams and $300 for eyewear, while other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) provides partially covered dental services with a $3,000 maximum annual benefit for both in-network and out-of-network care. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered services like exams, cleanings, and restorative care have no copay and no coinsurance, though 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 prior authorization, requiring 0% to 20% coinsurance for Part B chemotherapy, radiation, and other drugs, with no copay for other Part B drugs. Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance, and step therapy may apply.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment benefits under the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic services, are covered with a 20% coinsurance and no copay. Prior authorization is required for these items, 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 for all services. Diagnostic tests, lab services, diagnostic radiology, and outpatient X-rays have a 20% coinsurance and no copay, while therapeutic radiological services require a 20% coinsurance and a 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. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HumanaChoice - Diabetes and Heart (PPO C-SNP) plan with no copay and prior authorization required, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
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 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) provides other services including acupuncture for up to 20 treatments per year with no copay and 20% coinsurance. Over-the-counter items and chronic illness meal benefits are also covered 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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