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HumanaChoice SNP-DE H5216-205 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-205 (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 H5216-205 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-205 (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 Georgia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-205 (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 H5216-205 (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 H5216-205 (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 H5216-205 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced 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 $590.00 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 $14000.00 (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 $14000.00 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 HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs in each tier. However, the specific cost-sharing amounts for each tier are not provided in this summary. If you qualify for the low-income subsidy (LIS), you will pay $40.00 for Part D. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your Part D drugs.
Additional Benefits
The HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay of $2,185 per admission, while outpatient services and many primary care services have a 20% coinsurance. Emergency services have a $110 copay, and ambulance services have a $315 copay. Preventive services, like annual physical exams, and some vision and dental services, have no copay. The plan also covers home health services with no copay, and skilled nursing facility stays have no copay for the first 20 days. This plan also offers an over-the-counter item benefit up to $1200 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a copay of $2,185 per admission or stay, and additional days are covered with no copay. For Inpatient Hospital Psychiatric, there is a copay of $2,036 per admission or stay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance. Ambulatory Surgical Center and Outpatient Substance Abuse Services have a minimum and maximum coinsurance of 20%. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan. This plan covers both ground and air ambulance services, each with a $315 copay and no coinsurance, but Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each have a $110 copay.
Primary Care See details
The HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have a 20% coinsurance, while chiropractic services have no copay, and individual and group sessions for mental health and psychiatric services have a minimum and maximum 20% coinsurance.
Preventive Services See details
The HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, and other additional preventive services are not covered.
Hearing Services See details
Hearing Services are partially covered by the HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan, but Routine Hearing Exams, Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids (all types, inner ear, outer ear, and over the ear), and OTC Hearing Aids are not covered. Hearing Exams have a coinsurance of at most 20%, and there is no deductible.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a 20% coinsurance and no copay, while eyewear has no copay. However, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services with a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), and other preventive dental services have no copay, while fluoride treatment, endodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan, but require prior authorization. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance and Diabetic Supplies have a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts and Diabetic Supplies have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a 20% coinsurance, and lab services with no copay and a 20% coinsurance. Diagnostic radiological services have a copay of at most $325 and a 20% coinsurance, while outpatient X-ray services have a $50 copay and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, but a $214 copay applies for days 21-100, and there is no coinsurance.
Other Services See details
The HumanaChoice SNP-DE H5216-205 (PPO D-SNP) plan covers acupuncture with 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are also covered up to $1200 per year. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and other services are not covered.
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