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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 2026, 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 2026.
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 $1.90. 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 H5216-291 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-291 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using a standard pharmacy or preferred mail order for both 1-month and 3-month supplies. Standard mail order for these generic tiers requires copays ranging from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For higher-tier drugs, your cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs all require a 25% coinsurance across standard pharmacies, preferred mail order, and standard mail order. This 25% coinsurance rate applies to 1-month and 3-month supplies for Tiers 3 and 4, and 1-month supplies for Tier 5 specialty medications.
Additional Benefits
The HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan offers comprehensive healthcare coverage with predictable out-of-pocket costs. For primary and specialist doctor visits, members pay no copay and a 20% coinsurance, while inpatient hospital stays require a set copay of either $2,230 for acute care or $2,080 for psychiatric care. Emergency services carry a $115 copay that is waived if admitted, and urgent care is available for a $40 copay. This plan also includes valuable extra benefits to support your daily wellness, such as routine dental care up to a $4,000 annual limit and select hearing aids with no copay and no coinsurance. Routine vision exams and eyewear are covered with no copay and a 20% coinsurance up to annual limits, and home health services are available with no copay and no coinsurance. Additionally, members can access up to 24 free one-way transportation trips per year to plan-approved medical locations.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HumanaChoice SNP-DE H5216-291 (PPO D-SNP) with no coinsurance, requiring prior authorization and a copay of $2,230 per acute stay or $2,080 per psychiatric stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) covers outpatient hospital services with a $0 to $250 copay and 20% coinsurance, and ambulatory surgical center services with no copay and no coinsurance. Outpatient substance abuse and blood services are also covered with no copay and 20% coinsurance, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered under the HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, while telehealth services require a $0 to $40 copay and 20% coinsurance. Chiropractic services are partially covered, offering routine care with no copay and 20% coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice SNP-DE H5216-291 (PPO D-SNP) with no copays and no coinsurance for covered options like annual physicals, kidney disease education, and glaucoma screenings. Sub-services that are not covered include fitness benefits, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by HumanaChoice SNP-DE H5216-291 (PPO D-SNP) with no deductible, featuring no copay and no coinsurance for OTC hearing aids, fitting evaluations, and up to two prescription hearing aids every three years. Routine hearing exams require a 20% coinsurance and no copay, Medicare-covered exams require a copay, and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) vision services are partially covered, offering routine eye exams and eyewear with no copay and a 20% coinsurance, up to annual limits of $75 for exams and $200 for eyewear. There is no deductible for these services, but other eye exams, standalone eyeglass lenses, standalone frames, and upgrades are not covered.
Dental Services See details
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) provides partially covered dental services, featuring Medicare-covered dental care with no copay and 20% coinsurance, plus other preventive and comprehensive dental benefits with no copay and no coinsurance up to a $4,000 annual limit. Specific services not covered under this plan include fluoride, endodontics, removable or fixed prosthodontics, maxillofacial prosthetics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice SNP-DE H5216-291 (PPO D-SNP), requiring prior authorization and step therapy. Covered insulin requires a $35 copay and no coinsurance to 20% coinsurance, while other Medicare Part B drugs have no copay and chemotherapy drugs require a copay, with both carrying no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment covered by HumanaChoice SNP-DE H5216-291 (PPO D-SNP) includes durable medical equipment, prosthetics, medical supplies, and diabetic services, which generally require prior authorization. These benefits feature a 20% coinsurance and no copay, with diabetic supplies limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice SNP-DE H5216-291 (PPO D-SNP) with a 20% coinsurance and prior authorization required. Members will pay no copay for lab services, a $40 copay for outpatient X-rays, and copays ranging from $0 to $40 for diagnostic procedures and tests.
Home Health Services See details
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the HumanaChoice SNP-DE H5216-291 (PPO D-SNP) plan. Although the overall benefit has no copay, specific services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice SNP-DE H5216-291 (PPO D-SNP) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice SNP-DE H5216-291 (PPO D-SNP) covers select additional services, offering acupuncture with no copay and 20% coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and some other services in this category are not covered.
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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