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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 New Mexico. 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 $235.00 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) plan features an annual prescription drug deductible of $235. Beneficiaries enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at standard pharmacies or through preferred mail order. Standard mail order options for these lower tiers range from no copay for Tier 6 up to a $20 copay for a 1-month Tier 2 generic supply. For higher-tier medications, the plan transitions to a coinsurance model where you pay a percentage of the drug cost. Tier 3 preferred brands and Tier 4 non-preferred drugs require a 25% coinsurance at standard pharmacies and mail-order services for both 1-month and 3-month supplies. Tier 5 specialty drugs carry a 30% coinsurance for a 1-month supply across all standard pharmacy and mail-order options.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers comprehensive medical coverage, including inpatient hospital stays with fixed copays starting at $2,080 and no coinsurance. Outpatient hospital services, primary care visits, specialist consultations, and dialysis generally require no copay and a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if admitted, while urgent care services carry a $40 copay. This plan also provides robust supplemental benefits, featuring no copay and no coinsurance for preventive care, home health services, cardiac rehabilitation, and up to 36 one-way transportation trips. Dental, vision, and hearing services are partially covered, offering generous annual allowances and routine exams with no copays. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. 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, but upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services with no copay and a 20% coinsurance. Outpatient blood services are covered with no copay and no coinsurance, with prior authorization required for these outpatient services.
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 these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under HumanaChoice - Diabetes and Heart (PPO C-SNP), requiring prior authorization for all services. Ground ambulance services have a $330 copay and air ambulance services have a $630 copay with no coinsurance, while plan-approved transportation is covered with no copay or coinsurance for up to 36 one-way trips per year (transportation to any health-related location is not covered).
Emergency Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and emergency transportation services are also covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, while telehealth benefits range from a $0 to $40 copay with 20% coinsurance. Chiropractic services are partially covered, offering routine care for up to 12 visits per year with no copay and 20% coinsurance, but other chiropractic services are not covered.
Preventive Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) offers partial coverage for preventive services, featuring no copay and no coinsurance for covered services like annual physical exams, kidney disease education, glaucoma screenings, and memory fitness. However, several supplemental services are not covered, including health education, in-home safety assessments, medical nutrition therapy, weight management programs, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by HumanaChoice - Diabetes and Heart (PPO C-SNP), offering Medicare-covered exams, fitting evaluations, and OTC hearing aids with no copays and no coinsurance. Routine exams are covered annually with no copay and a 20% coinsurance, and prescription hearing aids are covered up to two every three years with no copay or coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers vision services, offering one annual routine eye exam with no copay and 20% coinsurance up to a $40 limit, alongside eyewear with no copay and no coinsurance up to a $300 annual maximum. Other eye exam services, individual eyeglass lenses, 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 Medicare-covered dental with no copay and 20% coinsurance, alongside other dental services up to a $2,000 annual limit with no copay and no coinsurance. While most preventive and comprehensive services are included, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Home Infusion bundled Services with prior authorization, featuring a $35 copay and 0% to 20% coinsurance for Medicare Part B insulin. Other covered Part B drugs, including chemotherapy and radiation, carry a 0% to 20% coinsurance with no copay for general Part B drugs, and step therapy may apply.
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 to receive these covered services.
Medical Equipment See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with a 20% coinsurance and no copay. 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 and radiological services with a 20% coinsurance and prior authorization required. Lab services and diagnostic radiological services have no copay, while diagnostic procedures and tests range from a $0 to $40 copay, and outpatient X-rays require a $40 copay.
Home Health Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Home Health Services 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 copay and no coinsurance, but require prior authorization. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation 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) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, but a prior three-day inpatient hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) provides partially covered other services, featuring acupuncture with no copay and 20% coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
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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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