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Medicare Advantage · C-SNP · Local PPO · 2027

HumanaChoice - Diabetes and Heart (PPO C-SNP)

Humana H5216-4434.0 CMS rating for 2027
Is it offered where you live?

No referral needed to see a specialist

At a glance: $0 monthly premium and $0 primary care visits.

Eligibility required for this C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. See who can enroll

Monthly premium
$0
Part B premium separate
Yearly limit
$9,850
Most you’d pay for in-network care
OTC allowance
$75/month
OTC allowance
Doctor visits
$0
Primary care · specialists 20%

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Add your doctors and prescriptions to see how they work with this plan.

Your doctors
Not checked yetSee if they’re in this plan’s network
Your prescriptions
Not checked yetSee your drug tier and monthly cost
Extra benefits
7 includedOTC allowance · Dental · Vision · Hearing · Fitness · Transportation · Meals

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Enrollment options depend on where you live. Enter your ZIP code so we can show the right ways to enroll in this plan.

Who can enroll

Eligibility for this Special Needs Plan

Eligibility required for this C-SNP

The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Extra benefits for members who qualify

  • Food and produce benefit
  • Non-medical transportation benefit
  • General supports for living
  • Pest control service
  • Indoor air quality equipment and services
  • Social needs benefit

These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.

Costs and copays

Deductible, yearly limit, visits, hospital stays and drug tiers
Drug deductiblePer year
$700
Yearly limitIn-network care, not counting drugs
$9,850
Yearly limit, in and out of networkCombined, not counting drugs
$14,800
Primary doctorPer visit
$0
SpecialistPer visit · no referral needed
20%
Hospital stayNo limit on covered hospital days
$2,241 per stay
Inpatient mental healthHospital stay
$2,091 per stay
Outpatient surgeryPer procedure
$35
Emergency roomPer visit
$115
Urgent carePer visit
$40
Tier 1 · Preferred Generic30-day supply at a retail pharmacy
$0
Tier 2 · Generic30-day supply at a retail pharmacy
$0
Tier 3 · Preferred Brand30-day supply at a retail pharmacy, after deductible
17%
Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy, after deductible
50%
Tier 5 · Specialty30-day supply at a retail pharmacy, after deductible
25%
Tier 6 · Drugs30-day supply at a retail pharmacy, after deductible
$0

Our take

Where this plan shines, and what to know

Where this plan shines

  • This plan has a $0 monthly premium.
  • See your primary doctor for $0.
  • Highly rated by CMS (4 stars).

Things to know before you enroll

  • This plan’s out-of-pocket maximum is above the national median.
  • Limited coverage while traveling outside the plan’s service area.

Similar plans

Other Medicare Advantage plans offered in New Mexico

Common questions

6 answers about this plan

What does HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) cover?

HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) is a Chronic Condition Special Needs Plan, a Medicare Advantage plan for people whose qualifying condition the plan verifies, including cardiovascular disorders and diabetes. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 6 formulary tiers. Published supplemental benefits include dental ($750/yr preventive & comprehensive dental allowance), vision ($100/yr eyewear allowance), hearing ($0 copay per hearing aid), and over-the-counter (OTC) ($75/month OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) cost in 2027?

The published 2027 monthly plan premium for HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) is $0. Any Medicare premiums you owe are separate from the listed plan premium. The listed Part D deductible is $700. The in-network medical out-of-pocket maximum is $9,850; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits 20%. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO)?

CMS lists HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) as a Local PPO plan. The plan record says specialist referrals are not required. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

What chronic conditions qualify for HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO)?

HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) is listed in the current plan record as a C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Learn about Special Needs Plans

How does HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) coordinate care for my chronic condition?

HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) is identified in the current plan record as a Chronic Condition Special Needs Plan for qualifying conditions that include Cardio DIS CHF and Diabetes. The record also lists dental ($750/yr preventive & comprehensive dental allowance), vision ($100/yr eyewear allowance), and hearing ($0 copay per hearing aid). The data on this page does not describe a personal care plan or promise a specific care coordinator. Review the Evidence of Coverage and ask the plan how its model of care, provider communication, and medication support apply to your verified condition.

When can I enroll in HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO)?

HumanaChoice - Diabetes and Heart (PPO C-SNP) (Local PPO) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a C-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

Plan documents

Summary of Benefits and Evidence of Coverage

Enter your ZIP code to see how you can enroll

Enrollment options depend on where you live. Enter your ZIP code so we can show the right ways to enroll in this plan.

HumanaChoice - Diabetes and Heart H5216-443 (PPO C-SNP) — 2027