A non-government entity
HumanaChoice SNP-DE H5216-296 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-296 (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 H5216-296 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-296 (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 UT. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-296 (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 H5216-296 (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 H5216-296 (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 H5216-296 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.90. 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 H5216-296 (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice SNP-DE H5216-296 (PPO D-SNP) Medicare plan features a yearly prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled through standard pharmacies or preferred mail order services. If you choose standard mail order, Tier 1 drugs require a $10 copay for a 1-month supply and Tier 2 drugs require a $20 copay. For brand-name and specialty medications, the plan transitions to a coinsurance model. Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance across standard pharmacies and mail order services. This 25% cost-sharing applies to 1-month and 3-month supplies for Tiers 3 and 4, and 1-month supplies for Tier 5.
Additional Benefits
The HumanaChoice SNP-DE H5216-296 (PPO D-SNP) plan offers comprehensive coverage for core medical services, generally featuring a 20% coinsurance and no copay for primary care visits, outpatient services, and durable medical equipment. Inpatient hospital stays require a set copayment per stay with no coinsurance, while emergency care carries a $115 copay. Preventive care and home health services are fully covered with no copay and no coinsurance. This plan also provides valuable supplemental benefits, including dental, vision, and hearing care that feature no copays and varying coinsurance or annual allowance limits. Members can access up to 36 one-way transportation trips per year to plan-approved locations, as well as over-the-counter items and chronic illness meals with no copay and no coinsurance. Additionally, skilled nursing facility stays offer no copay for the first 20 days, helping to keep your health-related expenses predictable.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-296 (PPO D-SNP) covers inpatient hospital services with no coinsurance, requiring prior authorization and a copayment of $2,230 per stay for acute care and $2,080 per stay for psychiatric care. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-296 (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and 20% coinsurance. Prior authorization is required for these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
HumanaChoice SNP-DE H5216-296 (PPO D-SNP) covers partial hospitalization with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice SNP-DE H5216-296 (PPO D-SNP), with ground ambulance requiring a $335 copay plus coinsurance and air ambulance requiring a 20% coinsurance plus a copay. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-296 (PPO D-SNP) covers emergency room services with a $115 copay and no coinsurance, which is 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 H5216-296 (PPO D-SNP) primary care benefits are generally covered with no copay and 20% coinsurance for PCP visits, specialist care, psychiatric services, and physical therapy. Telehealth services require a $0 to $40 copay and 20% coinsurance, while podiatry is not covered, and only some chiropractic services are covered since routine and other chiropractic services are excluded.
Preventive Services See details
HumanaChoice SNP-DE H5216-296 (PPO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, and diabetes self-management training. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, alternative therapies, and home-support services.
Hearing Services See details
Hearing services covered by HumanaChoice SNP-DE H5216-296 (PPO D-SNP) include routine exams with a 20% coinsurance and no copay, as well as fitting evaluations and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision Services are partially covered by HumanaChoice SNP-DE H5216-296 (PPO D-SNP) with no deductibles. Routine eye exams feature no copay and a 20% coinsurance up to a $75 annual limit, while contact lenses and eyeglasses (lenses and frames) are covered with no copay and no coinsurance up to a $100 annual limit. Other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice SNP-DE H5216-296 (PPO D-SNP) partially covers dental services, providing Medicare-covered dental with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $2,500 annual limit. Fluoride treatments, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice SNP-DE H5216-296 (PPO D-SNP) with prior authorization, requiring no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance, while other Part B drugs have no copay.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5216-296 (PPO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment benefits under the HumanaChoice SNP-DE H5216-296 (PPO D-SNP) plan, including durable medical equipment, prosthetics, and diabetic supplies, are covered with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, and prior authorization is required for most of these services.
Diagnostic and Radiological Services See details
HumanaChoice SNP-DE H5216-296 (PPO D-SNP) covers diagnostic and radiological services with a 20% coinsurance, requiring prior authorization for all services. Diagnostic procedures and tests carry a copay of $0 to $40, lab services have no copay, outpatient X-rays require a $40 copay, and diagnostic radiological services have a $200 copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice SNP-DE H5216-296 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under HumanaChoice SNP-DE H5216-296 (PPO D-SNP) with no copay, but intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HumanaChoice SNP-DE H5216-296 (PPO D-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and 86 to 100, a $218 daily copay for days 21 to 85, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered by HumanaChoice SNP-DE H5216-296 (PPO D-SNP) include acupuncture with no copay and 20% coinsurance (up to 20 treatments yearly), plus over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while other additional services under this benefit 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
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved