HumanaChoice - Diabetes and Heart (PPO C-SNP)

3.5 out of 5 stars
$0.00
Monthly Premium

HumanaChoice - Diabetes and Heart (PPO C-SNP) is a PPO C-SNP plan offered by Humana Inc.

Plan ID: H5216-375

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as HumanaChoice - Diabetes and Heart (PPO C-SNP) - H5216-375 by Humana Inc. as well as other Medicare Advantage plans available in your area.

$0.00
Monthly Premium

Michigan Counties Served

AlleganArenacBarryBayBerrienBranchCalhounCassClareClintonEatonGeneseeGladwinGratiotHillsdaleHuronInghamIoniaIsabellaJacksonKalamazooKentLakeLapeerLenaweeLivingstonMacombMasonMecostaMidlandMonroeMontcalmMuskegonNewaygoOaklandOceanaOsceolaOttawaSaginawSaint ClairSaint JosephSanilacShiawasseeTuscolaVan BurenWashtenawWayne

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $300
Out of Pocket Max In-Network: $6550
Out-of-Network: 6550
Initial Coverage Limit $0
Catastrophic Coverage Limit $2100
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Specialty Doctor Visit

Out-of-Network:

Doctor Specialty Visit Services:
Copayment for Medicare Covered Physician Specialist Office Visit $40
Inpatient Hospital Care

Out-of-Network:

Acute Hospital Services:
$530 per day for days 1 to 5
$0 per day for days 6 to 90
Urgent Care

Urgent Care:
Copayment for Urgent Care $50

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $130
Emergency Room Visit

Emergency Care:
Copayment for Emergency Care $130
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $130
Copayment for Worldwide Emergency Transportation $130
Ambulance Transportation

Out-of-Network:

Ambulance Services:
Copayment for Medicare Covered Ambulance Services - Ground $335
Copayment for Medicare Covered Ambulance Services - Air $335

Health Care Services and Medical Supplies

HumanaChoice - Diabetes and Heart (PPO C-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services

Out-of-Network:

Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $15
In-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $15
Prior Authorization Required for Chiropractic Services
Diabetes Supplies, Training, Nutrition Therapy and Monitoring

Out-of-Network:

Diabetic Supplies and Services:
Coinsurance for Medicare Covered Diabetic Supplies 20%
Copayment for Medicare Covered Diabetic Therapeutic Shoes or Inserts $0
Durable Medical Equipment (DME)

Out-of-Network:

Durable Medical Equipment Services:
Coinsurance for Medicare Covered Durable Medical Equipment 20%
$0 Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy20% DME - DME Prov20% DME - Pharmacy
Diagnostic Tests, Lab and Radiology Services, and X-Rays

Out-of-Network:

Diagnostic Procedures/Tests Services:
Copayment for Medicare Covered Diagnostic Procedures/Tests
$0 to $100
Copayment for Medicare Covered Lab Services
$0 to $50
Copayment for Medicare Covered Diagnostic Radiological Services $0 to $780
Copayment for Medicare Covered Therapeutic Radiological Services $35
Coinsurance for Medicare Covered Therapeutic Radiological Services 20%
Copayment for Medicare Covered Outpatient X-Ray Services $0 to $130
$100 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$40 OP Diag Proc & Tests - SPC$50 OP Diag Proc & Tests - UCC$100 Sleep Study (Fac Based) - OPH$30 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home
Home Health Care
In-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$650 per day for days 1 to 3
$0 per day for days 4 to 90
Prior Authorization Required for Psychiatric Hospital Services
Mental Health Outpatient Care

Out-of-Network:

Mental Health Services:
Copayment for Medicare Covered Individual Sessions $35
Copayment for Medicare Covered Group Sessions $35
Outpatient Services / Surgery

Out-of-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0 to $530
Copayment for Medicare Covered Ambulatory Surgical Center Services $0 to $430
$0 Diag Colonoscopy - OPH$35 Mental Health - OPH$530 Surgery Svcs - OPH$40 Wound Care - OPH
Outpatient Substance Abuse Care
In-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $35
Copayment for Medicare-covered Group Sessions $35
Prior Authorization Required for Outpatient Substance Abuse Services

Out-of-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual Sessions $35
Copayment for Medicare Covered Group Sessions $35
Over-the-counter (OTC) Items
Healthy Options Allowance: Members diagnosed with a qualifying chronic health condition may receive a $50 monthly allowance on a prepaid spending card to use at participating retail locations for essentials needed to support their health. Plus, members can also use this money for eligible groceries, utilities, rent, and more. Any unused amount rolls over each month and expires at the end of the plan year or upon disenrollment, whichever occurs first.
Podiatry Services
In-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $40
Prior Authorization Required for Podiatry Services

Out-of-Network:

Podiatry Services:
Copayment for Medicare Covered Podiatry Services $40
Skilled Nursing Facility Care

Out-of-Network:

Skilled Nursing Facility Services:
$10 per day for days 1 to 20
$218 per day for days 21 to 100

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
$0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years.
$0 copayment for comprehensive oral evaluation or periodontal exam, occlusal adjustment, scaling for moderate inflammation up to 1 every 3 years.
$0 copayment for crown recementation, panoramic film or diagnostic x-rays up to 1 every 5 years.
$0 copayment for root canal, root canal retreatment up to 1 per tooth per lifetime.
$0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year.
$0 copayment for adjustments to dentures, denture rebase, denture reline, denture repair, emergency diagnostic exam, tissue conditioning up to 1 per year.
$0 copayment for emergency treatment for pain, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year.
$0 copayment for periodontal maintenance up to 4 per year.
$0 copayment for amalgam and/or composite filling, simple or surgical extraction up to unlimited per year.
$0 copayment for necessary anesthesia with covered service up to as needed with covered codes.
30% coinsurance for complete dentures, partial dentures up to 1 every 5 years.
30% coinsurance for other restorative services - core buildup and prefabricated post and core up to 1 per tooth per lifetime.
30%-40% coinsurance for crown up to 1 per tooth per lifetime.
$2,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0 to $40
Copayment for Routine Eye Exams $0
  • Maximum 1 Routine Eye Exams every year
Prior Authorization Required for Eye Exams
$0 Diab Eye Exam - All POTs$40 Vision Svcs (MC) - SPC

Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0
  • Maximum 1 Pair every year
Copayment for Eyeglasses (lenses and frames) $0
  • Maximum 1 Pair every year
Maximum Plan Benefit of $250 every year
Members must use Humana's Medicare Insight Network, a national network of providers, which includes standard or PLUS providers. The allowance for the standard network is $100 less than the PLUS network.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $40
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0
Prior Authorization Required for Hearing Exams

Hearing Aids:
Copayment for Hearing Aids $699 to $999
  • Maximum 2 Hearing Aids every year

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
Tobacco use cessation
Yearly "Wellness" visit

Prescription Drug Costs and Coverage

The HumanaChoice - Diabetes and Heart (PPO C-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $300 (excludes Tiers 1, 2 and 6) per year.

Coverage Cost
Coverage & Cost
Annual Drug Deductible $300 (excludes Tiers 1, 2 and 6)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $10.00
Generic
  • Preferred cost-share mail order $10.00
  • Standard retail $10.00
  • Standard mail order $20.00
Select Care Drugs
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $11.00
Annual Drug Deductible $300 (excludes Tiers 1, 2 and 6)
Preferred Generic
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Generic
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Select Care Drugs
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Annual Drug Deductible $300 (excludes Tiers 1, 2 and 6)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $30.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $30.00
  • Standard mail order $60.00
Select Care Drugs
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $33.00
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