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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 2025, 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 3.5 out of 5 stars in 2025.
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 $42.40. 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 $590.00 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 HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services and primary care typically involve coinsurance. Emergency and ambulance services have copays, and preventive services often have no copay. The plan also covers hearing and vision services, with cost-sharing for exams and eyewear. Dental services include coverage for various procedures with no copay. Additional benefits include home infusion, dialysis, medical equipment, and diagnostic services, all with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with a copay of $2185 per admission or stay, and Inpatient Hospital Psychiatric with a copay of $2036 per admission or stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $250 copay and 20% coinsurance, Observation Services with a $500 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay and 20% coinsurance, Outpatient Substance Abuse Services with 20% coinsurance for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 15% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan. Ground and Air Ambulance Services have a copay of $315, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have a 20% coinsurance, and the additional telehealth benefits have a copay of $0-$45. Mental health specialty services, psychiatric services, and opioid treatment program services each have a minimum and maximum coinsurance of 20%. The plan does not cover routine chiropractic care and podiatry services.
Preventive Services See details
The HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan covers preventive services including an annual physical exam with no copay, and other services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. Additional preventive services are also covered, but require prior authorization. Some services are not covered, including 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, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services. The plan also covers kidney disease education services with no copay, and fitness benefits with no copay.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams and no copay. Prescription hearing aids are partially covered, with no copay for prescription hearing aids (all types), but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan covers vision services including eye exams with no copay and 20% coinsurance, and eyewear with 20% coinsurance. Contact lenses and eyeglasses (lenses and frames) have no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, and other dental services including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, restorative services, adjunctive general services, endodontics, prosthodontics, implant services, and oral and maxillofacial surgery, all with no copay. Periodontics, maxillofacial prosthetics, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is no copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan, but require prior authorization. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 20% coinsurance and no copay, while medical supplies have a 20% coinsurance and no copay. Diabetic supplies have a 20% coinsurance and no copay, while diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
The HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests have a maximum copay of $45 and a coinsurance of up to 20%, while lab services have no copay and a coinsurance of up to 20%. Diagnostic radiological services have a copay of up to $325 and a coinsurance of up to 20%, therapeutic radiological services have a coinsurance of up to 20%, and outpatient X-ray services have a $45 copay and a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by HumanaChoice SNP-DE H5970-020 (PPO D-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice SNP-DE H5970-020 (PPO D-SNP) plan covers acupuncture with 20% coinsurance, and a meal benefit with no copay. The plan also offers up to $1200 per year for over-the-counter items, including nicotine replacement therapy and Naloxone, but does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management, or other services.
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