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Humana Dual Select H5216-298 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H5216-298 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Dual Select H5216-298 (PPO D-SNP) in 2025, please refer to our full plan details page.
Humana Dual Select H5216-298 (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 2025.
It's important to know that Humana Dual Select H5216-298 (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:
Humana Dual Select H5216-298 (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 Humana Dual Select H5216-298 (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 Humana Dual Select H5216-298 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 Humana Dual Select H5216-298 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay costs for your prescriptions based on the drug tier until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered Part D drugs. This plan's premium is $47.30 per month if you qualify for the low-income subsidy.
Additional Benefits
The Humana Dual Select H5216-298 (PPO D-SNP) plan offers a range of benefits, including inpatient hospital stays with a substantial copay, and outpatient services with varying copays and coinsurance. The plan also covers ambulance services, emergency services, and a variety of primary care services, with costs dependent on the specific service. Preventive services, such as annual physical exams, are covered with no copay, while the plan offers hearing, vision, and dental services with varying costs. Home infusion, dialysis, and medical equipment are covered with copays and coinsurance, and home health services are covered with no copay. Additionally, the plan includes coverage for acupuncture and over-the-counter items, with a yearly maximum benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. The copay for a Medicare-covered stay is $2050 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 for Inpatient Hospital-Acute, 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, including all outpatient hospital services, observation services, and outpatient substance abuse services are covered. Outpatient hospital services have a 20% coinsurance and a copay between $0 and $550, while observation services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Individual and group outpatient substance abuse sessions have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Dual Select H5216-298 (PPO D-SNP) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Dual Select H5216-298 (PPO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all services have no coinsurance.
Primary Care See details
The Humana Dual Select H5216-298 (PPO D-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, and routine chiropractic care has a $15 copay for up to 12 visits per year. Occupational therapy services have a $20 copay, and physician specialist services have a $50 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services have a copay of $30, and physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a copay that ranges from $0 to $50.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional services, including smoking cessation counseling and fitness benefits, with no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered.
Hearing Services See details
The Humana Dual Select H5216-298 (PPO D-SNP) plan covers hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Dual Select H5216-298 (PPO D-SNP) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $50, while routine eye exams, contact lenses, and eyeglasses (lenses and frames) have no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Dual Select H5216-298 (PPO D-SNP) plan offers dental services with a $1,500 annual maximum benefit, and covers Medicare Dental Services with a $50 copay. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics, fixed are covered with no copay. Fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Dual Select H5216-298 (PPO D-SNP). The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with coinsurance and copays, though specific costs may vary. Durable Medical Equipment for use outside the home is not covered. Diabetic supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay required for some services. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of at most $650, and Therapeutic Radiological Services have a coinsurance of at least 20% and a copay of at least $50.
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 specific services of Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Dual Select H5216-298 (PPO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Dual Select H5216-298 (PPO D-SNP) plan covers acupuncture with a $50 copay per visit, up to 20 treatments per year, and requires prior authorization. Over-the-counter (OTC) items are covered with a maximum benefit of $1200 per year, including nicotine replacement therapy and naloxone, but does not cover all drugs on the CMS OTC list. The plan also offers a meal benefit for chronic illness with no copay, but other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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