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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 $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 $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 $10100.00 (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 $10100.00 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. You can minimize your out-of-pocket costs with no copay for Tier 1 preferred generics and Tier 6 select care drugs when using standard pharmacies or preferred mail order. Tier 2 generic medications are also highly affordable, requiring no copay for a three-month supply filled via preferred mail order or a $10 copay for a one-month supply at standard pharmacies. For higher-tier medications, Tier 3 preferred brands carry a $47 copay for a one-month supply, which can be reduced to $94 for a three-month supply through preferred mail order. Tier 4 non-preferred drugs require a 50% coinsurance across all fulfillment options. Tier 5 specialty drugs are subject to a 25% coinsurance for a one-month supply, ensuring predictable cost-sharing for your specialized medical needs.
Additional Benefits
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers comprehensive coverage for essential health needs, featuring no copay for primary care visits, mental health services, and annual physical exams. Specialized medical care is highly accessible, with specialist visits requiring a $20 copay and outpatient surgical services available with no copay. For hospital stays, members pay a $325 daily copay for the first six days of inpatient acute care and daily copays for skilled nursing facility stays, with no coinsurance required for either. This plan also includes valuable supplemental benefits, offering routine vision exams, preventive dental care, and over-the-counter hearing aids with no copay. For more advanced medical needs, diagnostic services, dialysis, and durable medical equipment generally carry a 20% coinsurance with no copay. Additionally, emergency services are covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional acute days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital visits require a copay of $0 to $300 ($325 per stay for observation services), while individual and group substance abuse therapy sessions have a copay of $0 to $35.
Partial Hospitalization See details
The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, with no coinsurance required for either service. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while 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 require a $45 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 physician, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits require a $20 copay and therapy services require a $30 copay with no coinsurance. Some chiropractic services are covered but routine and other chiropractic services are not, while podiatry services are not covered by the plan.
Preventive Services See details
Preventive Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes training, digital rectal exams, and EKGs. However, the benefit is only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers hearing services with no deductible and no coinsurance, offering Medicare-covered exams for a $20 copay, and routine exams and OTC hearing aids with no copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $99 to $699 for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) offers partially covered vision services with no coinsurance and no copay for one annual routine eye exam and covered eyewear, which has a $450 annual limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) offers partially covered dental services with a $3,500 annual limit, featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive care. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with a 20% coinsurance and no copay. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice - Diabetes and Heart (PPO C-SNP), subject to prior authorization. Outpatient X-rays and lab services have no copay, while other diagnostic tests and radiological services carry a 20% coinsurance and copays ranging up to $45.00.
Home Health Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers Cardiac Rehabilitation Services with prior authorization, though some services are covered while Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered in practice. Covered rehabilitation services require either a $10 copay with no coinsurance, or a 20% coinsurance with no copay.
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. You will pay a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 70, and no copay for days 71 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice - Diabetes and Heart (PPO C-SNP) covers acupuncture with a $20 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance, both requiring prior authorization. Over-the-counter items are also covered via reimbursement with no copay and no coinsurance, though some CMS OTC list items are excluded.
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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* 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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