HumanaChoice SNP-DE H5216-227 (PPO D-SNP)

HumanaChoice SNP-DE H5216-227 (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 Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that HumanaChoice SNP-DE H5216-227 (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 H5216-227 (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 prescription drug coverage for the HumanaChoice SNP-DE H5216-227 (PPO D-SNP) plan includes an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard pharmacies or preferred mail order for one-month and three-month supplies. Alternatively, choosing standard mail order for these generic tiers results in a copay of $10 to $20 for a one-month supply and $30 to $60 for a three-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance rather than a flat copay. This 25% coinsurance applies to one-month and three-month supplies for Tiers 3 and 4, and one-month supplies for Tier 5 specialty drugs, regardless of whether you use standard pharmacies, preferred mail order, or standard mail order.

Additional Benefits

The HumanaChoice SNP-DE H5216-227 (PPO D-SNP) plan offers robust medical coverage, featuring inpatient hospital stays with no coinsurance and fixed copays of $2,230 for acute stays and $2,080 for psychiatric stays. Primary care, specialist visits, and outpatient services generally require a 20% coinsurance and no copay, while home health services are fully covered with no copay and no coinsurance. Emergency care carries a $115 copay that is waived upon admission, and skilled nursing facility stays require no copay for the first 20 days. The plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay and no coinsurance up to a $1,250 annual limit. Vision and hearing benefits feature routine exams and eyewear coverage up to $200 with no copay, alongside fully covered over-the-counter hearing aids. Furthermore, members can receive over-the-counter items and chronic illness meal benefits with no copay and no coinsurance.