HumanaChoice SNP-DE H5216-220 (PPO D-SNP)

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 2026.

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.

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.

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:

Drug Coverage

The HumanaChoice SNP-DE H5216-220 (PPO D-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using standard retail pharmacies or preferred mail order services for both 1-month and 3-month supplies. However, choosing standard mail order for these generic tiers introduces a copay ranging from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For higher-tier medications, including Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan requires a consistent 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order channels. The coinsurance rate covers 1-month and 3-month supplies for Tiers 3 and 4, and 1-month supplies for Tier 5 specialty prescriptions.

Additional Benefits

The HumanaChoice SNP-DE H5216-220 (PPO D-SNP) plan offers comprehensive medical coverage with varying cost-sharing structures depending on the service. For acute inpatient hospital stays, members pay a $2,230 copay per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if admitted. Most outpatient services, primary care visits, specialist consultations, and dialysis require no copay but are subject to a 20% coinsurance. Preventive care, home health services, and select dental care are covered with no copay and no coinsurance, though dental benefits are capped at a $5,000 annual maximum. Vision and hearing benefits feature no copays for routine exams and select hardware, though some services require a 20% coinsurance. Skilled nursing facility stays require no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.