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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 2025, 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 2025.
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 $50.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $6.00. 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 H5216-268 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs depending on the tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5216-268 (PPO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services and primary care often have a 20% coinsurance. Preventive services, hearing exams, vision exams, and many dental services have no copay. The plan also includes coverage for ambulance services, with a copay for ground transport and coinsurance for air ambulance. Additionally, it covers home health services with no copay and offers benefits for medical equipment, home infusion, and skilled nursing facilities. The plan also offers an over-the-counter benefit with a maximum of $1200 per year, and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, there is a copay of $2,185 per admission, and additional days are covered with no copay; however, Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, there is a copay of $2,036 per admission, while Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center (ASC) services with a 20% coinsurance. Outpatient substance abuse services are covered with a 20% coinsurance, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a 19% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay, and are limited to 100 one-way trips per year via taxi, bus/subway, or medical transport.
Emergency Services See details
Emergency Services are covered under the HumanaChoice SNP-DE H5216-268 (PPO D-SNP) plan, with a $110 copay. Urgently Needed Services have a 20% coinsurance, and 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 H5216-268 (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, with a 20% coinsurance for many of these services. Chiropractic services and mental health specialty services require prior authorization, and routine chiropractic care is not covered.
Preventive Services See details
The HumanaChoice SNP-DE H5216-268 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, also have no copay.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with no copay for all types of prescription hearing aids, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay and 20% coinsurance, and eyewear with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams are limited to 1 per year. Eyewear has a combined maximum of $500 per year.
Dental Services See details
The HumanaChoice SNP-DE H5216-268 (PPO D-SNP) plan covers Medicare Dental Services with 20% coinsurance and other dental services with a maximum benefit of $5,000 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but there are limits on the number of visits for each service. Fluoride treatment, maxillofacial prosthetics, implant services, 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, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have no copay and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5216-268 (PPO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has an 18% coinsurance with no copay, while Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic procedures/tests have a coinsurance of at most 20% and no copay. Lab services have a coinsurance of at most 20% and no copay. Diagnostic radiological services have a coinsurance of at most 20% and a copay of at most $350, and therapeutic radiological services and outpatient X-ray services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the HumanaChoice SNP-DE H5216-268 (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 Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and coinsurance applies for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice SNP-DE H5216-268 (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 SNF stays, and non-Medicare-covered SNF stays, are not covered.
Other Services See details
Under Other Services, acupuncture is covered with 20% coinsurance and up to 20 treatments per year. Over-the-counter (OTC) items are covered with a maximum benefit of $1200 per year. The meal benefit is covered with no copay. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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