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HumanaChoice SNP-DE H5216-219 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-219 (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 H5216-219 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-219 (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 Arkansas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-219 (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 H5216-219 (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 H5216-219 (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 H5216-219 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.90. 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 $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:
Sign up for HumanaChoice SNP-DE H5216-219 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan has a deductible of $590. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D will be $20.90.
Additional Benefits
The HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan offers a range of health benefits. Inpatient hospital stays have a high copay, while many outpatient services, like blood services, have no copay. The plan covers preventive services like annual physicals and hearing services, including hearing exams and hearing aids. Vision services include eye exams and eyewear with no copay. Dental services have a $2,000 annual maximum, with many services having no copay. The plan also includes coverage for ambulance and transportation services, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $2095.00 per admission or stay, with additional days covered at no copay, while non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $2036.00 per admission or stay, with additional days and non-Medicare-covered stays not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a minimum and maximum of 20% coinsurance, and Outpatient Substance Abuse Services including individual and group sessions with a minimum and maximum of 20% coinsurance. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to a plan-approved health-related location with no copay. 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 HumanaChoice SNP-DE H5216-219 (PPO D-SNP). Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, and Urgently Needed Services has a 20% coinsurance.
Primary Care See details
The HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. The plan also covers Individual and Group sessions for Mental Health and Psychiatric Services with a 20% coinsurance. Chiropractic Services, Occupational Therapy Services, Other Health Care Professional, and Opioid Treatment Program Services also have a 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are also covered with no copay. However, other additional preventive services such as health education, in-home safety assessment, and others are not covered.
Hearing Services See details
The HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan covers hearing exams with a coinsurance of at most 20% for routine hearing exams, and also covers fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, and a maximum of $500 per ear, every year. OTC hearing aids are covered with no copay, up to 2 per year, and a maximum of $500 per ear, every year.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $2,000 maximum benefit per year. Medicare Dental Services have a 20% coinsurance and require prior authorization, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, and Prosthodontics, fixed, and Oral and Maxillofacial Surgery services all have no copay. Fluoride Treatment, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%, while Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have no copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 19% coinsurance with no copay, and Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered, with prior authorization required. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Lab Services have no copay; Outpatient X-Ray Services have a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice SNP-DE H5216-219 (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 not covered by the HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan. The plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, requiring prior authorization, with no copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The HumanaChoice SNP-DE H5216-219 (PPO D-SNP) plan covers acupuncture with a 20% coinsurance, and up to 20 treatments per year. Over-the-counter (OTC) items are covered, with a maximum benefit coverage amount of $1200 per year, and the plan offers Nicotine Replacement Therapy (NRT). The plan also covers a meal benefit with no copay. However, 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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