A non-government entity
Humana Together in Health (PPO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Together in Health (PPO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Together in Health (PPO I-SNP) in 2025, please refer to our full plan details page.
Humana Together in Health (PPO I-SNP) is a PPO I-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Together in Health (PPO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Together in Health (PPO I-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 Humana Together in Health (PPO I-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 Humana Together in Health (PPO I-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 $470.00 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 $14000.00 (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 $14000.00 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 Humana Together in Health (PPO I-SNP) plan has a $470 deductible for prescription drugs. After the deductible is met, you will pay the following costs for your prescriptions depending on the drug tier and pharmacy. For a 30-day supply, you will pay no copay for preferred generic drugs at a standard or preferred mail pharmacy, or a $20 copay at a standard mail pharmacy. Standard generic, preferred brand, and non-preferred drugs have a 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Together in Health (PPO I-SNP) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for primary care and preventive services, with a copay for inpatient hospital stays for the first few days. Additional benefits include coverage for outpatient services, hearing, vision, and dental services, along with home health and skilled nursing facility care. The plan also covers emergency services, ambulance services, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you pay a $598 copay for days 1-4, and no copay for days 5-90, with no coinsurance. Inpatient Hospital Psychiatric has a $1872 copay, with no coinsurance.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered with a 20% coinsurance. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services have no copay. Transportation Services to any health-related location are limited to 36 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Together in Health (PPO I-SNP) plan. Emergency Services has a $110 copay, while Urgently Needed Services has a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Together in Health (PPO I-SNP) plan offers primary care services with no copay. Chiropractic services have no copay, but routine care is not covered. Occupational therapy services have no coinsurance and no copay. Physician specialist services have a 20% coinsurance. Mental health specialty services, including individual and group sessions, have a 20% coinsurance. Podiatry services, including routine foot care, have a 20% coinsurance. Other health care professional services have a 20% coinsurance and no copay. Psychiatric services, including individual and group sessions, have a 20% coinsurance. Physical therapy and speech-language pathology services have no coinsurance and no copay. Additional telehealth benefits have a 20% coinsurance and no copay. Opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Humana Together in Health (PPO I-SNP) plan covers preventive services, including an annual physical exam with no copay. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit all have no copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a 20% coinsurance for routine exams, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids have a copay between $99 and $699 per year for all types of prescription hearing aids, while OTC hearing aids are covered up to $75 every three months.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Together in Health (PPO I-SNP) plan covers dental services, including Medicare Dental Services with 20% coinsurance, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin and other Medicare Part B drugs. You may have to pay a copay of $35 for Medicare Part B Insulin Drugs, and a coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Humana Together in Health (PPO I-SNP) plan. The coinsurance for dialysis services is 20%, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with coinsurance and copay, including specific coverage for Diabetic Supplies with 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests and diagnostic radiological services have a coinsurance of at most 20%, while lab services and outpatient X-ray services have a coinsurance of at most 20% and no copay. Therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Together in Health (PPO I-SNP) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by Humana Together in Health (PPO I-SNP). Prior authorization is required for these services, but none of the sub-services are covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Together in Health (PPO I-SNP) with prior authorization required, and there is no copay for days 1-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services," Humana Together in Health (PPO I-SNP) covers acupuncture with a 20% coinsurance, up to 20 treatments per year and OTC items with a maximum benefit of $75 every three months, including nicotine replacement therapy and naloxone. Meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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