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HumanaChoice SNP-DE H5216-220 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-220 (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 H5216-220 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-220 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-220 (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 H5216-220 (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 H5216-220 (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 H5216-220 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. 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 H5216-220 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your monthly Part D premium is $48.40. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5216-220 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including preventive services, hearing aid fitting/evaluation, vision eye exams, and dental services. However, some services like outpatient and primary care have a 20% coinsurance. The plan also covers additional services such as ambulance, emergency services, and transportation, each with specific copays. Additionally, the plan provides coverage for home health, skilled nursing, and medical equipment, with either no copay or a 20% coinsurance. It also covers hearing and vision services, as well as other services like acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the copay is not specified. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, as are Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all 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, while outpatient blood services have no copay. Ambulatory surgical center services and outpatient substance abuse services have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $315 copay. Transportation Services to a Plan Approved Health-related Location are also covered with no copay, for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by HumanaChoice SNP-DE H5216-220 (PPO D-SNP). Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a 20% coinsurance.
Primary Care See details
The HumanaChoice SNP-DE H5216-220 (PPO D-SNP) plan's primary care benefit covers primary care physician services, chiropractic services, occupational therapy services, 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. The plan has a 20% coinsurance for primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits, while routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include no copay for annual physical exams, and other services. Also covered are additional sessions of smoking and tobacco cessation counseling with no copay for 4 visits. Additional services such as health education, home safety assessments, and more are not covered.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams. Fitting/evaluation for hearing aids has no copay, and prescription hearing aids have a maximum benefit of $500 per ear, every year with no copay for all types of prescription hearing aids. OTC hearing aids are covered with a $0 copay and a maximum benefit of $500 per ear, every year.
Vision Services See details
Vision services include eye exams with no copay and 20% coinsurance, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum benefit of $5,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics fixed, and oral and maxillofacial surgery are covered with no copay, but have visit limits. However, fluoride treatments, prosthodontics removable, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%, and for Other Medicare Part B Drugs there is no copay.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice SNP-DE H5216-220 (PPO D-SNP), with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance. Prosthetics/Medical Supplies and Diabetic Equipment are also covered, with 20% coinsurance for Prosthetic Devices, Medicare-covered Medical Supplies, and Medicare-covered Diabetic Therapeutic Shoes or Inserts. There is no copay for Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of up to 20%, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of up to $325 and a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice SNP-DE H5216-220 (PPO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice SNP-DE H5216-220 (PPO D-SNP). 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
The HumanaChoice SNP-DE H5216-220 (PPO D-SNP) plan covers acupuncture with 20% coinsurance, and a meal benefit with no copay. The plan also covers over-the-counter items, including nicotine replacement therapy and naloxone, up to $1200 per year. However, this plan does not cover 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, or Self-Directed Personal Assistance Services.
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