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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 2026, 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 2026.
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 $25.40. 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:
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Drug Coverage
The Humana Dual Select H5216-206 (PPO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug coverage tier details, including individual copayments and coinsurance rates, are currently unavailable for this plan. To fully understand your potential out-of-pocket medication costs, it is recommended to verify how your specific prescriptions are categorized under this plan's formulary.
Additional Benefits
The Humana Dual Select H5216-206 (PPO D-SNP) offers comprehensive medical coverage with no copay or coinsurance for primary care visits and standard preventive services. Specialist visits, physical therapy, and Medicare-covered dental exams require a low $25 copay, while emergency room visits carry a $115 copay that is waived if you are admitted. For inpatient hospital stays, members pay a $399 daily copay for the first five to six days and no copay for the remaining covered days. This plan also includes valuable supplemental benefits, such as no copay for routine annual vision and hearing exams, along with allowances of up to $250 for eyewear and coverage for two prescription hearing aids every three years. Dental services are covered up to a $1,500 annual limit with no copay for most covered care. Additionally, home health services feature no copay, while durable medical equipment, dialysis services, and select Part B drugs require a 20% coinsurance.
Inpatient Hospital See details
Humana Dual Select H5216-206 (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for stays. Covered acute stays incur a $399 daily copay for days 1 to 6 with no copay for additional days, while psychiatric stays require a $399 daily copay for days 1 to 5 and no copay for days 6 to 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Dual Select H5216-206 (PPO D-SNP) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $450 (with a $399 copay per stay for observation services), while outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Dual Select H5216-206 (PPO D-SNP) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Dual Select H5216-206 (PPO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered under the Humana Dual Select H5216-206 (PPO D-SNP) plan 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 $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Dual Select H5216-206 (PPO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services carry a $35 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under Humana Dual Select H5216-206 (PPO D-SNP) are partially covered, providing Medicare-covered preventive services, annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. However, additional preventive benefits such as fitness programs, health education, weight management, nutritional services, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Dual Select H5216-206 (PPO D-SNP), featuring Medicare-covered exams for a $25 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered every three years with no copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Dual Select H5216-206 (PPO D-SNP) vision services are partially covered, featuring no copay, no coinsurance, and no deductible for one annual routine eye exam (up to $75) and one annual pair of eyeglasses or contact lenses (up to $250). Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Dual Select H5216-206 (PPO D-SNP) partially covers dental services up to a $1,500 annual limit for both in-network and out-of-network care, offering Medicare-covered dental services for a $25 copay and no coinsurance, and other covered services with no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Dual Select H5216-206 (PPO D-SNP) covers home infusion bundled services with prior authorization and step therapy. Medicare Part B chemotherapy, radiation, and other drugs require up to 20% coinsurance, with other Part B drugs having no copay, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Dual Select H5216-206 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Humana Dual Select H5216-206 (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic supplies, with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, though prior authorization is required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Dual Select H5216-206 (PPO D-SNP), requiring prior authorization. Outpatient lab, X-ray, and diagnostic radiological services feature no copay, while diagnostic procedures and therapeutic radiological services require a 20% coinsurance with copays ranging from $0 to $120 depending on the service.
Home Health Services See details
Home health services are covered by Humana Dual Select H5216-206 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Dual Select H5216-206 (PPO D-SNP) covers Cardiac Rehabilitation Services with no coinsurance, but the benefit is not covered in practice as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Dual Select H5216-206 (PPO D-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Dual Select H5216-206 (PPO D-SNP) partially covers other services, offering acupuncture for a $25 copay and no coinsurance for up to 20 treatments per year, alongside a meal benefit for chronic illness with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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