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HumanaChoice SNP-DE H5216-292 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-292 (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 H5216-292 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-292 (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 Mississippi. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-292 (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 H5216-292 (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 H5216-292 (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 H5216-292 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 H5216-292 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-292 (PPO D-SNP) Medicare plan has an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one-month or three-month supplies when filled at standard pharmacies or through preferred mail order. If you choose standard mail order for these generic tiers, copays range from $10 to $20 for a one-month supply and $30 to $60 for a three-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance across standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The HumanaChoice SNP-DE H5216-292 (PPO D-SNP) plan offers comprehensive medical coverage, featuring no copay and a 20% coinsurance for primary care and specialist visits. For inpatient hospital stays, members pay a copay of $2,070 per acute stay and $1,870 per psychiatric stay with no coinsurance, while outpatient hospital services require a $550 copay and 20% coinsurance. Emergency care is covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes essential everyday benefits, such as home health services, over-the-counter items, and up to 36 annual one-way transportation trips with no copay and no coinsurance. Routine preventive and comprehensive dental services are covered with no copay or coinsurance up to a $1,500 annual limit, while covered eyewear features no copay or coinsurance up to a $300 annual limit. Additionally, fitting evaluations and over-the-counter hearing aids are provided with no copay and no coinsurance.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-292 (PPO D-SNP) covers inpatient hospital care with no coinsurance, requiring a $2,070 copay per acute stay and a $1,870 copay per psychiatric stay. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP), featuring a $550 copay and 20% coinsurance for outpatient hospital services, and a $400 copay and 20% coinsurance for ambulatory surgical center services. Outpatient substance abuse and blood services are covered with no copay and 20% coinsurance, with prior authorization required for most of these care options.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-292 (PPO D-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 36 annual one-way trips to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-292 (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 20% coinsurance up to $40 and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice SNP-DE H5216-292 (PPO D-SNP) covers primary care, specialist visits, therapies, and mental health services with no copay and a 20% coinsurance. Chiropractic care is partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP) with no copays and no coinsurance for covered care, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. Supplemental benefits like in-home support, memory fitness, and chemotherapy-related wigs (up to $500 yearly) are also covered with no copay, while services such as health education, nutritional therapy, and home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP) with no deductible, offering fitting evaluations and OTC hearing aids with no copay and no coinsurance. Routine hearing exams require a 20% coinsurance and no copay, while prescription hearing aids are partially covered with no copay and no coinsurance, excluding inner ear, outer ear, and over the ear hearing aids.
Vision Services See details
HumanaChoice SNP-DE H5216-292 (PPO D-SNP) partially covers vision services with no deductible, offering routine eye exams with no copay and 20% coinsurance up to a $40 annual limit. Covered eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay and no coinsurance up to a $300 annual limit, but other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP), featuring no copay and no coinsurance for covered preventive and comprehensive services up to a $1,500 annual limit, while Medicare-covered dental services require a 20% coinsurance and no copay. Fluoride treatments, endodontics, implants, orthodontics, oral and maxillofacial surgery, maxillofacial prosthetics, and fixed or removable prosthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP) with prior authorization, requiring a $35 copay and 0% to 20% coinsurance for Part B insulin. Other Medicare Part B drugs feature no copay and 0% to 20% coinsurance, while chemotherapy and radiation drugs require a copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive this care.
Medical Equipment See details
HumanaChoice SNP-DE H5216-292 (PPO D-SNP) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment 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
Diagnostic and radiological services are covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP), with prior authorization required and a 20% coinsurance applying to all services. Lab services feature no copay, outpatient X-rays require a $50 copay, diagnostic radiological services have a minimum $200 copay, and other diagnostic procedures and therapeutic radiological services also require copayments.
Home Health Services See details
HumanaChoice SNP-DE H5216-292 (PPO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
HumanaChoice SNP-DE H5216-292 (PPO D-SNP) offers Cardiac Rehabilitation Services with no copay, 20% coinsurance, and a prior authorization requirement. While some services are covered, specific sub-services including standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by HumanaChoice SNP-DE H5216-292 (PPO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with additional days beyond the standard Medicare-covered limit not covered.
Other Services See details
HumanaChoice SNP-DE H5216-292 (PPO D-SNP) partially covers other services, excluding highly integrated services. Covered acupuncture has no copay and a 20% coinsurance, while over-the-counter items and chronic illness meals are provided with no copay and no coinsurance.
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