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HumanaChoice SNP-DE H7617-038 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H7617-038 (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 H7617-038 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H7617-038 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in UT. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H7617-038 (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 H7617-038 (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 H7617-038 (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 H7617-038 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.70. 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 H7617-038 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H7617-038 (PPO D-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using standard pharmacies or preferred mail order services. Standard mail order services for these generic tiers require copays ranging from $10 to $30 for Tier 1 and $20 to $60 for Tier 2 depending on the supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance across standard pharmacies and mail order options. This 25% coinsurance applies to both 1-month and 3-month fills for Tiers 3 and 4, and to 1-month fills for Tier 5 specialty medications. Knowing these exact copays and coinsurance rates helps you estimate your annual prescription expenses with this HumanaChoice plan.
Additional Benefits
The HumanaChoice SNP-DE H7617-038 (PPO D-SNP) plan offers comprehensive medical coverage, with many outpatient, primary care, and specialist services requiring no copay and a 20% coinsurance. Emergency care is available with a $115 copay, while inpatient hospital stays require a $2,230 copay per acute stay. Preventive care and home health services are fully covered with no copay and no coinsurance, helping policyholders manage their routine health costs. This plan also features robust supplemental benefits, including up to $3,500 in annual dental coverage with no copay and no coinsurance for most preventive and comprehensive treatments. Hearing exams, prescription hearing aids, and annual eyewear are covered with no copay, though certain limits and coinsurance rates apply. Additionally, members benefit from up to 36 one-way transportation trips, over-the-counter items, and meal benefits with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits under HumanaChoice SNP-DE H7617-038 (PPO D-SNP) are partially covered with no coinsurance, requiring a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H7617-038 (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice SNP-DE H7617-038 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H7617-038 (PPO D-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H7617-038 (PPO D-SNP) covers emergency services with a $115 copay—which is waived if admitted to the hospital within 24 hours—and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with a $115 copay per service and no coinsurance.
Primary Care See details
Primary care benefits under HumanaChoice SNP-DE H7617-038 (PPO D-SNP) are generally covered with no copay and a 20% coinsurance, which applies to primary care, specialist, therapy, and mental health services. Additional telehealth benefits are covered with a $0.00 to $40.00 copay and 20% coinsurance, while podiatry is not covered and only some chiropractic services are covered since routine and other chiropractic care are excluded.
Preventive Services See details
Preventive services are partially covered by HumanaChoice SNP-DE H7617-038 (PPO D-SNP) with no copay and no coinsurance for covered benefits such as annual physical exams, smoking cessation, and glaucoma screenings. However, several supplemental services are not covered, including health education, personal emergency response systems, weight management, and nutritional benefits.
Hearing Services See details
Hearing services are covered by HumanaChoice SNP-DE H7617-038 (PPO D-SNP) with no deductible, offering fitting evaluations and OTC hearing aids with no copay and no coinsurance, alongside routine exams with a 20% coinsurance and no copay. Prescription hearing aids are partially covered with no copay and no coinsurance, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice SNP-DE H7617-038 (PPO D-SNP), offering one annual routine eye exam with no copay and 20% coinsurance up to a $75 yearly limit. Covered eyewear includes one annual pair of contact lenses or eyeglasses with no copay and no coinsurance up to a $100 limit, though individual frames, lenses, upgrades, and other eye exams are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice SNP-DE H7617-038 (PPO D-SNP), which offers up to $3,500 in annual benefits with no copay and no coinsurance for most preventive and comprehensive care, though Medicare-covered dental services require a 20% coinsurance and no copay. While many treatments like cleanings, fillings, and extractions are covered, fluoride treatments, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H7617-038 (PPO D-SNP) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin drugs for a $35 copay and coinsurance ranging from no coinsurance to 20%. Other Medicare Part B drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy and radiation drugs require a copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice SNP-DE H7617-038 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice SNP-DE H7617-038 (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice SNP-DE H7617-038 (PPO D-SNP) covers diagnostic and radiological services with prior authorization, all of which carry a 20% coinsurance. Lab services require no copay, outpatient X-rays have a $40 copay, diagnostic tests range from no copay up to a $40 copay, and diagnostic radiological services require a minimum $200 copay alongside copays for therapeutic services.
Home Health Services See details
HumanaChoice SNP-DE H7617-038 (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 H7617-038 (PPO D-SNP) does not cover Cardiac Rehabilitation Services in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered, requiring a 20% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice SNP-DE H7617-038 (PPO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 86 through 100, a $218 daily copay for days 21 through 85, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice SNP-DE H7617-038 (PPO D-SNP) covers acupuncture with no copay and 20% coinsurance, alongside meal benefits and over-the-counter items which both feature no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while highly integrated dual-eligible services and other miscellaneous services are not covered.
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