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Humana Dual Select H5216-206 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H5216-206 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Dual Select H5216-206 (PPO D-SNP) in 2025, please refer to our full plan details page.
Humana Dual Select H5216-206 (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 Humana Dual Select H5216-206 (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:
Humana Dual Select H5216-206 (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 Humana Dual Select H5216-206 (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 Humana Dual Select H5216-206 (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 $9350.00 (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 $9350.00 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 Humana Dual Select H5216-206 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you will pay $40 per month for Part D. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Dual Select H5216-206 (PPO D-SNP) plan offers a range of benefits, including inpatient hospital care with a copay, outpatient services with copays and coinsurance, and emergency services with a copay. It also provides primary care and specialist visits with copays, as well as preventive services with no copay for many services. The plan covers hearing and vision services with copays, and includes dental services, home infusion, dialysis, and medical equipment with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $399 copay for days 1-6, and no copay for days 7-90, with no coinsurance, and additional days 91-999 have no copay and no coinsurance. For Inpatient Hospital Psychiatric, you pay a $399 copay for days 1-5, and no copay for days 6-90, with no coinsurance. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Humana Dual Select H5216-206 (PPO D-SNP) plan covers outpatient services, including outpatient hospital services with a 20% coinsurance and a copay between $25 and $450, observation services with a $399 copay, and ambulatory surgical center (ASC) services with a $400 copay and 20% coinsurance. The plan also covers outpatient substance abuse services, including individual and group sessions with a copay between $45 and $100, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Dual Select H5216-206 (PPO D-SNP) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Dual Select H5216-206 (PPO D-SNP) plan. Ground and Air Ambulance Services have a copay of $315, with no coinsurance, while 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 Humana Dual Select H5216-206 (PPO D-SNP) plan. For Emergency Services, there is a $110 copay and no coinsurance, and the copay is waived if admitted to the hospital within 24 hours; for Urgently Needed Services, there is a $45 copay and no coinsurance; and for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, there is a $110 copay and no coinsurance.
Primary Care See details
The Humana Dual Select H5216-206 (PPO D-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. Specialist services have a $25 copay, while mental health and psychiatric services have a minimum copay of $45. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay ranging from $0 to $45. Opioid treatment program services have a minimum copay of $45, and a maximum copay of $100. Podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, Medicare-covered services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
The Humana Dual Select H5216-206 (PPO D-SNP) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $25 and routine eye exams with no copay. Eyewear is covered with no copay, but eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $25 copay, oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, other preventive dental services with no copay, restorative services with no copay, adjunctive general services with no copay, endodontics with no copay, periodontics with no copay, prosthodontics (removable) with no copay, prosthodontics (fixed) with no copay, and oral and maxillofacial surgery with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1,000 maximum plan benefit coverage amount per year.
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, and Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Humana Dual Select H5216-206 (PPO D-SNP) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and no copay. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Medical Supplies have no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Diabetic Supplies have no copay and Diabetic Therapeutic Shoes/Inserts have a copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay up to $120 and at least 20% coinsurance, lab services with no copay, and diagnostic radiological services with a copay up to $325. Therapeutic radiological services have a copay up to $25 and at least 20% coinsurance, while outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Dual Select H5216-206 (PPO D-SNP) plan, with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services are not covered. The plan does not specify any cost sharing information for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Dual Select H5216-206 (PPO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services offered by the Humana Dual Select H5216-206 (PPO D-SNP) plan include acupuncture with a $25 copay, and a meal benefit with no copay; however, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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