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HumanaChoice SNP-DE H5216-291 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-291 (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 H5216-291 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Maine. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-291 (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 H5216-291 (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 H5216-291 (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 H5216-291 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.40. 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 H5216-291 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you'll pay the costs for drugs in each tier until your total drug costs reach $2000, after which you enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you have LIS, you'll pay $14.40 for Part D.
Additional Benefits
The HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance amounts. Emergency, primary care, preventive, and home health services are covered, with some services having no copay, such as an annual physical exam and home health services. The plan also includes coverage for hearing, vision, dental, and other services like medical equipment and home infusion, with specific cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization required. The copay for a Medicare-covered stay is $2185 for Inpatient Hospital-Acute and $2036 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $250 copay and 20% coinsurance, Observation Services with a $500 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay and 20% coinsurance, Outpatient Substance Abuse Services with 20% coinsurance for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $315 copay. Transportation Services to a plan-approved health-related location are covered with no copay, for a maximum of 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan covers Primary Care Physician Services with a 20% coinsurance, Chiropractic Services with 20% coinsurance and no copay for routine care, Occupational Therapy Services with a 20% coinsurance, Physician Specialist Services with a 20% coinsurance, Mental Health Specialty Services with 20% coinsurance, Podiatry Services with 20% coinsurance and no copay for routine foot care, Other Health Care Professional with a 20% coinsurance, Psychiatric Services with 20% coinsurance, Physical Therapy and Speech-Language Pathology Services with a 20% coinsurance, Additional Telehealth Benefits with a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services with a 20% coinsurance.
Preventive Services See details
The HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services require prior authorization, and some services have a copay; however, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing services include routine hearing exams with no copay, and a coinsurance of at most 20% for some services, as well as fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are covered up to $50 every month.
Vision Services See details
Vision Services include eye exams with a 20% coinsurance and no copay, and eyewear benefits including contact lenses and eyeglasses with a 20% coinsurance, and with eyeglasses (lenses and frames) having no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, other dental services with a $4,000 maximum benefit per year, and no copay for oral exams (3 per year), dental X-rays (3 per year), other diagnostic dental services (1 every 3 years), prophylaxis (cleaning, 2 per year), and other preventive dental services (4 per year). Fluoride treatment, endodontics, prosthodontics removable, maxillofacial prosthetics, implant services, prosthodontics fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with 0-20% coinsurance, and no copay.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and no copay, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a maximum coinsurance of 20% and a copay up to $45, and Lab Services have a maximum coinsurance of 20% with no copay. Diagnostic Radiological Services have a maximum coinsurance of 20% and a copay up to $325, while Therapeutic Radiological Services have a maximum coinsurance of 20%. Outpatient X-Ray Services have a maximum coinsurance of 20% and a $45 copay.
Home Health Services See details
Home Health Services are covered 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 the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services", this plan covers acupuncture with a 20% coinsurance, and a meal benefit with no copay. The plan also covers over-the-counter items, with a maximum benefit of $50.00 per month. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, or the other additional services listed.
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