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HumanaChoice SNP-DE H5216-227 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-227 (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 H5216-227 (PPO D-SNP) in 2025, please refer to our full plan details page.
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 2025.
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.
Important:
HumanaChoice SNP-DE H5216-227 (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 H5216-227 (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.
For HumanaChoice SNP-DE H5216-227 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.90. 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:
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Drug Coverage
The HumanaChoice SNP-DE H5216-227 (PPO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $29.90. During the initial coverage phase, you pay the cost-sharing amounts for your drugs until your total drug costs reach $2,000. After this, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5216-227 (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a high copay, while outpatient services include copays and coinsurance. Emergency services, including ambulance, have copays, and primary care, preventive services, and many other services have 20% coinsurance. This plan offers additional benefits such as hearing exams, vision exams, and dental services with no or low copays and/or coinsurance. It also includes coverage for home health services, skilled nursing facilities, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $2185 and $2036 per admission or stay, respectively. Additional days for Inpatient Hospital-Acute are also covered with no copay, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $250 copay and 20% coinsurance, observation services with a $500 copay, Ambulatory Surgical Center (ASC) services with a $250 copay and 20% coinsurance, and outpatient substance abuse services and outpatient blood services with no copay. Outpatient blood services also include the enhanced benefit of three pints with the deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice SNP-DE H5216-227 (PPO D-SNP). Ground and Air Ambulance Services have a $315 copay, and there is no coinsurance. 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 the HumanaChoice SNP-DE H5216-227 (PPO D-SNP) plan. Emergency Services has a $110 copay and no coinsurance, while Urgently Needed Services has a $45 copay and no coinsurance; Worldwide Emergency Services has a $110 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice SNP-DE H5216-227 (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 with 20% coinsurance. This plan does not cover Podiatry Services.
Preventive Services See details
Preventive Services include Medicare-covered services, annual physical exams with no copay, and additional services. Additional preventive services, kidney disease education services, and other preventive services may have a copay, with specific services such as glaucoma screenings, diabetes self-management training, and barium enemas having no copay.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have at most 20% coinsurance, and routine hearing exams have no copay, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) have no copay for 2 visits every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay and 20% coinsurance, with a maximum benefit of $75 per year. This plan also covers contact lenses and eyeglasses (lenses and frames) with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $1,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, but fluoride treatments, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, but prior authorization is required. You may have a copay of $35 for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for all drugs.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5216-227 (PPO D-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 18% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a coinsurance of at most 20% with a copay of at most $45.00, while Lab Services have a coinsurance of at most 20% with no copay. Diagnostic Radiological Services have a coinsurance of at most 20% with a copay of at most $325.00, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a coinsurance of at most 20% with a $45 copay.
Home Health Services See details
Home Health Services are covered 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 covered, but the plan does not cover the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice SNP-DE H5216-227 (PPO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The HumanaChoice SNP-DE H5216-227 (PPO D-SNP) plan covers acupuncture with 20% coinsurance, up to 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $1500 per year. The plan also offers a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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