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HumanaChoice SNP-DE H5216-268 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-268 (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 H5216-268 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-268 (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 Iowa. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-268 (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 H5216-268 (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 H5216-268 (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 H5216-268 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.90. 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 $615.00 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 $13900.00 (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 $13900.00 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:
Sign up for HumanaChoice SNP-DE H5216-268 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-268 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay for 1-month and 3-month supplies filled at standard pharmacies or through preferred mail order. However, standard mail order for these generic tiers requires a copay, ranging from $10 for Tier 1 to $20 for Tier 2 for a 1-month supply. For Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance regardless of whether you use standard pharmacies, preferred mail order, or standard mail order. This 25% coinsurance applies to both 1-month and 3-month supplies for Tiers 3 and 4, and 1-month supplies for Tier 5 specialty medications. This cost-sharing structure helps Medicare beneficiaries understand their potential out-of-pocket prescription costs.
Additional Benefits
The HumanaChoice SNP-DE H5216-268 (PPO D-SNP) plan offers comprehensive medical coverage, featuring no copay and a 20% coinsurance for outpatient services, primary care, and specialist visits. Inpatient hospital stays require no coinsurance but carry a copay of $2,230 per stay for acute care and $2,080 for psychiatric care. Additionally, preventive services, annual physicals, and home health services are fully covered with no copay and no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $5,000 annual limit and eyewear up to a $400 yearly limit, both with no copay and no coinsurance. Members can also take advantage of no copay and no coinsurance for up to 100 one-way transportation trips per year, over-the-counter items, and prescription hearing aids. Emergency care is covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and sub-services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under HumanaChoice SNP-DE H5216-268 (PPO D-SNP) with no copay and a 20% coinsurance. This coverage includes outpatient hospital, ambulatory surgical center, substance abuse, and blood services, which generally require prior authorization.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice SNP-DE H5216-268 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) covers ground ambulance services with a $335 copay and air ambulance services with 20% coinsurance, both requiring prior authorization. Plan-approved transportation services are covered with no copay or coinsurance for up to 100 one-way trips per year, though trips to non-approved health-related locations are not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits offered by HumanaChoice SNP-DE H5216-268 (PPO D-SNP) are covered with no copay and a 20% coinsurance for most services, including PCP, specialist, and therapy visits. Podiatry services are not covered under this plan, and chiropractic care is only partially covered, with routine and other chiropractic services excluded from coverage.
Preventive Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) preventive services are covered with no copay and no coinsurance for annual physicals, kidney disease education, and screenings. Additional preventive services are partially covered, offering a fitness benefit with no copay, but excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, home modifications, and counseling.
Hearing Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) covers hearing services with no deductible, offering one routine hearing exam per year with no copay and 20% coinsurance, and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, and over the ear hearing aids are not covered. Unlimited OTC hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) covers routine eye exams with no copay and a 20% coinsurance up to a $40 annual limit, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 yearly limit for contact lenses or complete eyeglasses, while individual frames, lenses, and upgrades are not covered.
Dental Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $5,000 annual limit. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) covers home infusion bundled services, with Medicare Part B insulin requiring a $35 copay and no coinsurance to 20% coinsurance. Other Medicare Part B drugs have no copay and no coinsurance to 20% coinsurance, while chemotherapy and radiation drugs require a copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice SNP-DE H5216-268 (PPO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) covers diagnostic and radiological services subject to prior authorization. Diagnostic tests, lab services, and outpatient X-rays require a 20% coinsurance and no copay, while diagnostic radiological services carry a 20% coinsurance and a $200 copay, and therapeutic radiological services require both a 20% coinsurance and a copay.
Home Health Services See details
Home health services are covered by HumanaChoice SNP-DE H5216-268 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by HumanaChoice SNP-DE H5216-268 (PPO D-SNP) with no copay and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice SNP-DE H5216-268 (PPO D-SNP) with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice SNP-DE H5216-268 (PPO D-SNP) covers select other services, including acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits, while other supplemental services are not covered. Acupuncture requires prior authorization and features no copay and a 20% coinsurance for up to 20 treatments annually, whereas OTC items and meal benefits are offered with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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