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Humana Dual Select H7617-039 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H7617-039 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Dual Select H7617-039 (PPO D-SNP) in 2026, please refer to our full plan details page.
Humana Dual Select H7617-039 (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 Humana Dual Select H7617-039 (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:
Humana Dual Select H7617-039 (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 Humana Dual Select H7617-039 (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 Humana Dual Select H7617-039 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.90. 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:
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Drug Coverage
The Humana Dual Select H7617-039 (PPO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. If you utilize standard mail-order services, Tier 1 drugs require a $10 copay for one month and $30 for three months, while Tier 2 drugs cost a $20 copay for one month and $60 for three months. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order services for covered filling periods. These straightforward cost-sharing details help you estimate your out-of-pocket costs when choosing this Humana PPO D-SNP plan.
Additional Benefits
The Humana Dual Select H7617-039 (PPO D-SNP) offers comprehensive medical coverage with no copay for primary care visits and routine preventive services. For specialized care, members pay a $30 copay for specialist visits, while emergency room services require a $115 copay that is waived if admitted. Inpatient hospital stays require a $300 copay for days 1 through 6, followed by no copay for days 7 through 90. This plan also includes robust supplemental benefits, featuring no copay for routine dental, vision, and hearing exams, alongside a $1,500 annual limit for covered dental care. Essential support services like home health care are covered with no copay, while durable medical equipment typically requires a 20% coinsurance. Additionally, members can utilize up to 36 free one-way transportation trips per year to plan-approved locations.
Inpatient Hospital See details
Humana Dual Select H7617-039 (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with prior authorization and no coinsurance, requiring a $300 copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, while additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Dual Select H7617-039 (PPO D-SNP) covers outpatient hospital services with a copay ranging from no copay to $295 and 20% coinsurance, and observation services with 20% coinsurance. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Humana Dual Select H7617-039 (PPO D-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
Humana Dual Select H7617-039 (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 and no coinsurance for up to 36 one-way trips per year to plan-approved locations, while transportation to any other health-related location is not covered.
Emergency Services See details
Humana Dual Select H7617-039 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require 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
Humana Dual Select H7617-039 (PPO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical, occupational, and speech therapy services feature no copay and 20% coinsurance, mental health and psychiatric sessions require a $35 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Humana Dual Select H7617-039 (PPO D-SNP) with no copay and no coinsurance, including annual physicals, kidney education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs. Additional preventive benefits are partially covered with no copay or coinsurance for smoking cessation and memory fitness, but health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Dual Select H7617-039 (PPO D-SNP) hearing services include Medicare-covered exams for a $30 copay and no coinsurance with no deductible, while routine exams, fitting evaluations, and OTC hearing aids have no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Dual Select H7617-039 (PPO D-SNP), featuring no copay and no coinsurance for a routine annual eye exam and select eyewear, though other eye exams carry a copay of up to $30.00 and no coinsurance. There are no deductibles, but annual coverage limits apply, and other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Dual Select H7617-039 (PPO D-SNP) provides partially covered dental services, featuring a $30 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for other covered services up to a $1,500 annual limit. While preventive and comprehensive care like cleanings, exams, and oral surgery are covered, fluoride treatments, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Dual Select H7617-039 (PPO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Dual Select H7617-039 (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Dual Select H7617-039 (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, 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
Diagnostic and radiological services are covered by Humana Dual Select H7617-039 (PPO D-SNP) with prior authorization, typically requiring a 20% coinsurance. Outpatient X-rays and lab services feature no copay, while diagnostic procedures and radiological services carry copays ranging from $0 to $40.
Home Health Services See details
Home Health Services are covered under the Humana Dual Select H7617-039 (PPO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Humana Dual Select H7617-039 (PPO D-SNP) with no copay, but prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Dual Select H7617-039 (PPO D-SNP) with no coinsurance, featuring no copay for days 1 to 20 and days 86 to 100, and a $218 daily copay for days 21 to 85. Prior authorization is required, no prior three-day inpatient hospital stay is needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Dual Select H7617-039 (PPO D-SNP) covers acupuncture with a $30 copay and no coinsurance, and chronic illness meal benefits with no copay and no coinsurance, both requiring prior authorization. Over-the-counter items are partially covered with no copay and no coinsurance via reimbursement, though some CMS OTC list drugs are excluded.
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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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