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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 2026 to people living in Select Counties in ID. This plan received an overall rating of 4.5 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 $14.90. 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 - Diabetes and Heart (PPO C-SNP)
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Drug Coverage
The HumanaChoice - Diabetes and Heart (PPO C-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, there is no copay when using standard retail pharmacies or preferred mail order. Additionally, Tier 6 (Select Care Drugs) are highly affordable with no copay required for standard pharmacy or mail order fills. For Tier 3 (Preferred Brand), Tier 4 (Non-Preferred Drug), and Tier 5 (Specialty Tier) medications, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacies as well as preferred and standard mail order options. If you choose standard mail order for generic drugs, Tier 1 costs between a $10 and $30 copay, while Tier 2 ranges from a $20 to $60 copay.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan provides comprehensive coverage for core medical services, featuring no copay and a 20% coinsurance for primary care, specialist, and therapy visits. For inpatient hospital stays, members pay a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay with no coinsurance, while emergency care is covered with a $115 copay. Outpatient hospital services generally range from no copay up to a $300 copay with a 20% coinsurance. This plan also emphasizes routine care by offering preventive services, home health visits, and over-the-counter benefits with no copay and no coinsurance. Routine hearing and vision exams require no copay with a 20% coinsurance, and the plan includes allowances for eyewear and dental services up to specified annual limits with no copay. Additionally, skilled nursing facility stays feature no copay for the first 20 days, ensuring affordable recovery support.
Inpatient Hospital See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay, both subject to prior authorization. Unlimited additional acute days are covered at no copay, but additional psychiatric days, non-Medicare-covered stays, and hospital upgrades are not covered.
Outpatient Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers outpatient services, including ambulatory surgical and blood services with no copay and no coinsurance. Outpatient hospital services require a $0 to $300 copay and 20% coinsurance, observation services cost a $728 copay per stay plus coinsurance, and outpatient substance abuse services feature no copay with a 20% coinsurance for individual and group sessions.
Partial Hospitalization See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HumanaChoice - Diabetes and Heart (PPO C-SNP), with prior authorization required. Medicare-covered ground ambulance services require a $335 copay and air ambulance services require a $1,250 copay with no coinsurance, while plan-approved transportation offers up to 24 one-way trips per year with no copay and no coinsurance (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 and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with 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 - Diabetes and Heart (PPO C-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Telehealth benefits are also covered with a 20% coinsurance and copays ranging from $0 to $40, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered under HumanaChoice - Diabetes and Heart (PPO C-SNP) with no copay and no coinsurance, which includes annual physical exams, kidney disease education, and diabetes self-management. However, additional preventive benefits are only partially covered, as the plan excludes 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, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers hearing services, including fitting evaluations and unlimited OTC hearing aids with no copay and no coinsurance. Routine exams are covered once per year with no copay and 20% coinsurance, while Medicare-covered exams require no copay and no coinsurance. Prescription hearing aids are partially covered for up to two aids yearly with a $699 to $999 copay and no coinsurance, though inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) partially covers vision services with no deductibles, providing one routine eye exam annually with no copay and 20% coinsurance up to $75. Covered eyewear has no copay and no coinsurance up to a $150 yearly limit for one pair of contact lenses or eyeglasses (lenses and frames), though other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice - Diabetes and Heart (PPO C-SNP), featuring Medicare-covered dental care with no copay and a 20% coinsurance, alongside other dental benefits with no copay and no coinsurance up to a $2,000 annual limit. Fluoride treatments, endodontics, implants, oral and maxillofacial surgery, orthodontics, maxillofacial prosthetics, and fixed or removable prosthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with prior authorization, featuring 0% to 20% coinsurance for Part B chemotherapy, radiation, and other drugs, with no copay for other Part B drugs. Covered Part B insulin requires a $35 copay and 0% to 20% coinsurance, and step therapy from Part B to Part D may be required.
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 services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic services. 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 prior authorization. Diagnostic procedures require no copay to a $45 copay with a minimum 20% coinsurance, while lab services require no copay and a coinsurance. Diagnostic radiological services require no copay, therapeutic radiological services require a copay, and outpatient X-rays require a $40 copay, with all three carrying a minimum 20% coinsurance.
Home Health Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers some Cardiac Rehabilitation Services with prior authorization, although cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered. These services carry a $10 copay for cardiac and intensive cardiac rehab, and a 20% coinsurance for pulmonary and SET services.
Skilled Nursing Facility (SNF) See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 86 to 100, a $218 copay for days 21 to 85, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) include acupuncture, which requires prior authorization and has no copay but a 20% coinsurance for up to 20 treatments per year. Additionally, over-the-counter items and chronic illness meal benefits are 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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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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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