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HumanaChoice SNP-DE H5216-164 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-164 (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 H5216-164 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-164 (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 H5216-164 (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 H5216-164 (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 H5216-164 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.20. 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 H5216-164 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-164 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for 1-month and 3-month supplies filled at standard pharmacies or through preferred mail order. If you choose standard mail order for these generic tiers, copays range from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance at standard pharmacies, preferred mail order, and standard mail order. This 25% coinsurance applies to both 1-month and 3-month supplies, with specialty tier medications limited to a 1-month supply.
Additional Benefits
The HumanaChoice SNP-DE H5216-164 (PPO D-SNP) plan offers comprehensive coverage for core medical needs, with inpatient acute hospital stays requiring a $2,230 copay and psychiatric stays requiring a $2,080 copay, both with no coinsurance. Most outpatient services, primary care visits, specialist consultations, and diagnostic tests require no copay but are subject to a 20% coinsurance. Additionally, emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable supplemental benefits, featuring preventive and comprehensive dental care up to a $5,000 annual limit with no copay and no coinsurance. Routine eye exams and hearing tests are covered with no copay and a 20% coinsurance, while prescription hearing aids and up to $350 in annual eyewear are available with no copay and no coinsurance. Members can also access home health services, over-the-counter items, and up to 100 one-way transportation trips per year to plan-approved locations with no copay and no coinsurance.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) partially covers inpatient hospital services with prior authorization required, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Covered acute stays require a $2,230 copay per stay and no coinsurance with unlimited additional days at no copay, while psychiatric stays require a $2,080 copay per stay and no coinsurance.
Outpatient Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) covers outpatient services, offering outpatient hospital, observation, ambulatory surgical center, and substance abuse services with no copay and 20% coinsurance. Outpatient blood services are covered with no copay, no coinsurance, and no deductible, with prior authorization required for these outpatient services.
Partial Hospitalization See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) covers ambulance and transportation services, requiring a $335 copay and no coinsurance for ground ambulance, and a 20% coinsurance with no copay for air ambulance. Transportation services are partially covered, offering up to 100 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-164 (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 20% coinsurance (up to a $40 maximum) and no copay, while worldwide emergency, urgent care, and emergency transportation are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care and specialty medical services are covered by HumanaChoice SNP-DE H5216-164 (PPO D-SNP) with no copay and a 20% coinsurance, with prior authorization required for most specialty care. Chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) partially covers preventive services with no copay and no coinsurance for annual physicals, memory fitness, kidney disease education, and select screenings. Sub-services that are not covered include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) covers hearing services with no deductible, offering routine hearing exams for a 20% coinsurance and no copay. Prescription hearing aids are partially covered with no copay and no coinsurance, though inner ear, outer ear, and over the ear models are not covered, while fitting evaluations and OTC hearing aids feature no copay and no coinsurance.
Vision Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) vision services are partially covered, offering one routine eye exam per year with no copay and 20% coinsurance up to a $40 annual maximum. Covered eyewear includes one annual pair of contact lenses or eyeglasses (lenses and frames) with no copay and no coinsurance up to a $350 yearly limit, though other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) partially covers dental services up to a $5,000 annual limit, featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. Non-covered services under this plan include fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) covers home infusion bundled services with prior authorization, requiring 0% to 20% coinsurance and a copayment for chemotherapy and radiation drugs. Covered Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance, while other Part B drugs feature 0% to 20% coinsurance with no copay.
Dialysis Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services 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 HumanaChoice SNP-DE H5216-164 (PPO D-SNP) with prior authorization required. Members pay a 20% coinsurance and no copay for diagnostic tests, lab services, and diagnostic radiology, while outpatient X-rays require a 20% coinsurance and therapeutic radiology requires a 20% coinsurance and a copay.
Home Health Services See details
HumanaChoice SNP-DE H5216-164 (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 H5216-164 (PPO D-SNP) covers Cardiac Rehabilitation Services with no copay and a 20% coinsurance, subject to prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for symptomatic peripheral artery disease rehabilitation services are not covered under this benefit.
Skilled Nursing Facility (SNF) See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) partially covers other services, offering acupuncture with no copay and 20% coinsurance for up to 20 treatments per year. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, while other highly integrated and additional services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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