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HumanaChoice SNP-DE H5216-277 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-277 (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 H5216-277 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-277 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-277 (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 H5216-277 (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 H5216-277 (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 H5216-277 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.60. 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 H5216-277 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the cost-sharing for drugs in each tier until your total drug costs reach $2,000. If you qualify for the low-income subsidy (LIS), you will pay $46.60 for Part D. Once your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan offers a variety of benefits. It covers inpatient hospital stays, outpatient services, and emergency services with varying copays and coinsurance. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, with many services having no copay. Additionally, the plan provides coverage for home health services, medical equipment, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a copay of $2185 and $2036 respectively per stay for Medicare-covered stays, and additional days for Inpatient Hospital-Acute with no copay. 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 Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance, Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial hospitalization is covered with a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan. Ground and Air Ambulance Services have a copay of $310, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan with a $110 copay, while Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each have a $110 copay.
Primary Care See details
Primary Care benefits include coverage for 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. Chiropractic Services have a $0 copay. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. Individual and Group sessions for Mental Health and Psychiatric Services have a 20% coinsurance. Occupational Therapy Services, and Opioid Treatment Program Services have a minimum and maximum coinsurance of 20%. Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered with no copay. However, 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, while fitting/evaluation for hearing aids has no copay and no coinsurance.
Vision Services See details
The HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare Dental Services with 20% coinsurance and other dental services with a $3,000 maximum benefit. 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 oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, and no copay.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by the HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a coinsurance of at most 20%, and lab services with a $0 copay and a coinsurance of at most 20%. The plan also covers diagnostic radiological services with a copay of at most $325, a coinsurance of at most 20%, therapeutic radiological services with a coinsurance of at most 20%, and outpatient X-ray services with a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice SNP-DE H5216-277 (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 specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required, and coinsurance applies.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100; however, additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit.
Other Services See details
The HumanaChoice SNP-DE H5216-277 (PPO D-SNP) plan covers acupuncture with a 20% coinsurance, up to 20 treatments per year, and also covers Over-the-Counter (OTC) items with a maximum benefit of $2400 per year. The plan also offers a meal benefit with no copay. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others are not covered.
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