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HumanaChoice SNP-DE H5216-228 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-228 (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 H5216-228 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-228 (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 Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-228 (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 H5216-228 (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 H5216-228 (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 H5216-228 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.80. 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 H5216-228 (PPO D-SNP) plan has a $590.00 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium is $49.80. After the deductible is met, you will pay costs for drugs in each tier until your total drug costs reach $2000.00, at which point you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with coinsurance, and no copay for ambulance services. The plan also covers primary care, preventive, hearing, vision, and dental services, with varying cost-sharing structures such as coinsurance and copays, and some services require prior authorization. Additionally, the plan provides coverage for home health services with no copay, medical equipment with coinsurance, and diagnostic and radiological services with copays and coinsurance. Other notable benefits include coverage for over-the-counter items, a meal benefit with no copay, and no copay for routine hearing exams.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has a copay of $2185 per admission or stay, and the plan covers additional days with no copay. Inpatient Hospital Psychiatric has a copay of $2036 per admission or stay.
Outpatient Services See details
Outpatient services include outpatient hospital services with a 19% - 20% coinsurance, observation services with a 20% coinsurance, and ambulatory surgical center (ASC) services with a 20% coinsurance. Outpatient substance abuse services have a 19% coinsurance for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 19% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan, with no copay for ambulance services. Medicare-covered ground and air ambulance services have a 20% 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. Emergency Services have a $110 copay and no coinsurance. Urgently Needed Services have a 20% coinsurance and no copay. Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice SNP-DE H5216-228 (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 services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance, and individual and group mental health and psychiatric sessions have a 19% coinsurance. Chiropractic services, occupational therapy services, mental health and psychiatric specialty services, additional telehealth benefits, and opioid treatment program services require prior authorization.
Preventive Services See details
The HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Routine hearing exams have no copay and a 20% coinsurance, with a limit of one exam per year. Fitting/evaluation for hearing aids have no copay, and prescription hearing aids (all types) have no copay, with a limit of two aids every three years. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with no copay. 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 are covered with 20% coinsurance, and other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan and require prior authorization. This plan covers Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 18% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment with coinsurance and copayments for Medicare-covered diabetic supplies and therapeutic shoes or inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have a $0 copay and a coinsurance of at most 20%. 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 under the HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan with no copay and no coinsurance. 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 any of the specific services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice SNP-DE H5216-228 (PPO D-SNP) plan covers acupuncture with 20% coinsurance, and also covers over-the-counter items up to $1200 per year. This plan also offers a meal benefit with no copay. Some other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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