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HumanaChoice SNP-DE H5970-020 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5970-020 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice SNP-DE H5970-020 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5970-020 (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HumanaChoice SNP-DE H5970-020 (PPO D-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 SNP-DE H5970-020 (PPO D-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 SNP-DE H5970-020 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.90. 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:
Sign up for HumanaChoice SNP-DE H5970-020 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5970-020 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Understanding this upfront cost is an important step when evaluating your overall yearly healthcare expenses. Specific drug coverage tier details, such as individual copays and coinsurance rates for different medication levels, are currently not available for this plan. To determine your actual out-of-pocket costs, you will need to check how your specific prescriptions are categorized under the plan's formulary relative to the annual deductible.
Additional Benefits
The HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan covers essential medical services, offering primary and specialist care with no copay and a 20% coinsurance. For hospital services, inpatient acute care requires a $2,230 copay per stay with no coinsurance, while emergency room visits carry a $115 copay. Outpatient hospital care carries a 20% coinsurance and a copay up to $250, though ambulatory surgical services and home health care require no copay and no coinsurance. This plan also includes key supplemental benefits like dental, vision, and hearing care, with routine dental and hearing aid coverage requiring no copay and no coinsurance. Routine eye exams are available with no copay and a 20% coinsurance, alongside a $200 annual allowance for eyeglasses and contact lenses. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and members can access over-the-counter items and meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copayment per stay for acute care and a $2,080 copayment per stay for psychiatric care. Prior authorization is required, and while unlimited additional acute care days are covered with no copay, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) outpatient services are covered, featuring ambulatory surgical center services with no copay and no coinsurance. Outpatient hospital and observation services require a $0 to $250 copay and 20% coinsurance, while outpatient substance abuse and blood services have no copay and 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice SNP-DE H5970-020 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under the HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan, which covers ground and air ambulance services requiring prior authorization, a $335 copay, and no coinsurance. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5970-020 (PPO D-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 care is available for a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Additional telehealth benefits are also covered with a copay of $0 to $40 and 20% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and select screenings. Services not covered under this plan include 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, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) covers hearing services with no deductible, including routine exams for a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, excluding inner ear, outer ear, and over the ear types, while over-the-counter hearing aids are covered with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by HumanaChoice SNP-DE H5970-020 (PPO D-SNP), offering one annual routine eye exam with no copay and 20% coinsurance up to a $75 limit. Eyewear is covered up to a $200 annual limit, featuring contact lenses with no copay and 20% coinsurance, and eyeglasses with no copay and no coinsurance; however, standalone eyeglass lenses, frames, upgrades, and other eye exams are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice SNP-DE H5970-020 (PPO D-SNP), featuring no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental has no copay and a 20% coinsurance. Excluded services that are not covered include other preventive dental, periodontics, maxillofacial prosthetics, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) covers home infusion bundled services with prior authorization, featuring a $35 copay and no coinsurance to 20% coinsurance for Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs carry no coinsurance to 20% coinsurance, with no copay required for miscellaneous Part B drugs.
Dialysis Services See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes or inserts are also covered with no copay, though diabetic supplies are subject to a 20% coinsurance and manufacturer limitations.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice SNP-DE H5970-020 (PPO D-SNP) subject to prior authorization and a 20% coinsurance. There is no copay for lab and diagnostic radiological services, while outpatient X-rays require a $40 copay and other diagnostic procedures and tests have a copay ranging from $0 to $40.
Home Health Services See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice SNP-DE H5970-020 (PPO D-SNP) features no copay for Cardiac Rehabilitation Services, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice SNP-DE H5970-020 (PPO D-SNP) with no coinsurance and no prior three-day inpatient hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by HumanaChoice SNP-DE H5970-020 (PPO D-SNP) include acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits. Acupuncture is available with no copay and a 20% coinsurance for up to 20 treatments per year, while OTC items and meal benefits are fully 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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