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HumanaChoice - Diabetes and Heart (PPO C-SNP) Medicare Special Need Plan H5216-443 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9850.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
1,889 beneficiaries
Last update:

Introduction

HumanaChoice - Diabetes and Heart is a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Humana. The plan uses a Preferred Provider Organization (PPO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H5216-443 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.

CMS reports 1,889 beneficiaries enrolled across all service areas. You must live in the plan's service area to enroll: See List.

Eligibility

HumanaChoice - Diabetes and Heart is a Medicare C-SNP plan for individuals with specific chronic conditions.

Special Needs Plan Type
Chronic Condition Special Needs Plan (C-SNP)
Medicare Requirement
Must have Medicare Part A and Part B
Special Needs Requirement
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes mellitus.
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Plan Benefits

HumanaChoice - Diabetes and Heart has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5216-443.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: $0 copay		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Specialist In-network: 20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Telehealth benefit In-network: $0-$40 copay, 20% coinsurance In-network: $0-$40 copay, 20% coinsurance
Routine chiropractic In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Fitness benefits Coming soon In-network: $0 copay
Out-of-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay
Out-of-network: 95% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Health transportation (non-emergency) Coming soon In-network: $0 copay
Out-of-network: $0 copay

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$345 copay, 20% coinsurance
Out-of-network: $0-$345 copay, 20% coinsurance		 In-network: $0-$300 copay, 20% coinsurance
Out-of-network: $0-$300 copay, 20% coinsurance
Lab services In-network: $0 copay
Out-of-network: $0-$30 copay, 20% coinsurance		 In-network: $0-$40 copay, 20% coinsurance
Out-of-network: $0-$40 copay, 20% coinsurance
Outpatient x-rays In-network: $0-$40 copay, 20% coinsurance
Out-of-network: $0-$40 copay, 20% coinsurance		 In-network: $40 copay, 20% coinsurance
Out-of-network: $40 copay, 20% coinsurance
Diagnostic tests and procedures In-network: $0-$40 copay, 20% coinsurance
Out-of-network: $0-$40 copay, 20% coinsurance		 In-network: $0-$40 copay, 20% coinsurance
Out-of-network: $0-$40 copay, 20% coinsurance

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $115 copay $115 copay
Worldwide emergency care Coming soon $115 copay
Urgent care $40 copay $40 copay
Inpatient hospital care In-network:
Tier 1
$2,241 per stay
Out-of-network:
$2,241 per stay		 In-network:
Tier 1
$2,230 per stay
Out-of-network:
$2,230 per stay
Skilled Nursing Facility In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$221 per day for days 21-100
$0 per stay		 In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$218 per day for days 21-100
$0 per stay
Ground ambulance In-network: $325 copay
Out-of-network: $325 copay		 In-network: $330 copay
Out-of-network: $330 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $35 copay
Out-of-network: $35 copay		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy In-network: $35 copay
Out-of-network: $35 copay		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Inpatient psychiatric hospital care In-network:
Tier 1
$2,241 per stay
Out-of-network:
$2,241 per stay		 In-network:
Tier 1
$2,230 per stay
Out-of-network:
$2,230 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: 20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Occupational therapy In-network: 20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay, 20% coinsurance
Out-of-network: $0 copay, 20% coinsurance		 In-network: $0 copay, 20% coinsurance
Out-of-network: $0 copay, 20% coinsurance
Durable medical equipment In-network: 20% coinsurance
Out-of-network: 20% coinsurance		 In-network: $0 copay, 20% coinsurance
Out-of-network: $0 copay, 20% coinsurance
Prosthetics In-network: 20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs (Medicare-covered) In-network: $0 copay, 0%-20% coinsurance
Out-of-network: $0 copay, 20% coinsurance		 In-network: $0 copay, 0%-20% coinsurance
Out-of-network: $0 copay, 20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Cleaning In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Periodontics In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Endodontics In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Restorative services In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Contact lenses In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames only Not covered Not covered
Eyeglass lenses only Not covered Not covered
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Upgrades Not covered Not covered

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay
Out-of-network: 95% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation In-network: $0 copay
Out-of-network: 95% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Prescription hearing aids In-network: $0 copay
Out-of-network: 95% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
OTC hearing aids In-network: $0 copay
Out-of-network: 95% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by HumanaChoice - Diabetes and Heart as a Part B benefit.

Prescription Drug Coverage

HumanaChoice - Diabetes and Heart includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

HumanaChoice - Diabetes and Heart (H5216-443-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($49.90)
Supplemental Part D Premium:$49.90
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$6.26
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Humana starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, HumanaChoice - Diabetes and Heart may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

HumanaChoice - Diabetes and Heart (H5216-443-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$0.00 copay$0.00 copay
Preferred Brand17% coinsurance25% coinsurance
Non-Preferred Drug50% coinsurance25% coinsurance
Specialty Tier25% coinsurance30% coinsurance
Select Care Drugs$0.00 copay$0.00 copay
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H5216)

CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.

2027 Medicare Star Ratings for Contract H5216
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Humana (official source) http://www.humana.com/medicare October 4, 2026
CMS.gov Chronic Condition Special Needs Plans (C-SNPs) April 28, 2026
CMS.gov Medicare Advantage Plan Fact Sheet April 28, 2026
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage April 28, 2026

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.