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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 2026, 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 2026.
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 $23.80. 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:
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Drug Coverage
The Humana Dual Select H5216-298 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for 1-month or 3-month supplies filled at standard pharmacies or through preferred mail order. If you use standard mail order for these generic tiers, you will pay copays ranging from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance applies to both 1-month and 3-month supplies at standard pharmacies, preferred mail order, and standard mail order, with specialty tier drugs limited to 1-month supplies.
Additional Benefits
The Humana Dual Select H5216-298 (PPO D-SNP) plan offers comprehensive coverage designed to minimize out-of-pocket costs, featuring no copays or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $50 copay, while emergency room visits carry a $115 copay which is waived if you are admitted. Outpatient services vary, with ambulatory surgical centers requiring no copay and outpatient hospital visits ranging from no copay to a $550 copay plus coinsurance. For inpatient hospital stays, members pay a $2,230 copay per stay for acute care and a $2,080 copay for psychiatric care with no coinsurance. The plan also covers routine dental services up to a $2,500 annual limit, routine eye exams, and over-the-counter hearing aids with no copays or coinsurance. Additionally, members benefit from up to 36 one-way routine transportation trips per year and chronic illness meals with no copay or coinsurance.
Inpatient Hospital See details
Humana Dual Select H5216-298 (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Dual Select H5216-298 (PPO D-SNP) covers outpatient services, offering ambulatory surgical center and outpatient blood services with no copay and no coinsurance. Outpatient hospital services require a copay of $0 to $550 plus coinsurance, observation services carry a 20% coinsurance and a copay, and outpatient substance abuse sessions have a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Dual Select H5216-298 (PPO D-SNP) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Dual Select H5216-298 (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 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Dual Select H5216-298 (PPO D-SNP) covers emergency 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, with none of these costs counting toward your plan deductible.
Primary Care See details
Humana Dual Select H5216-298 (PPO D-SNP) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $50 copay and no coinsurance. Other covered services include physical and occupational therapy at a $20 copay, mental health, psychiatric, podiatry, and opioid treatments at a $35 copay, and routine chiropractic care at a $15 copay (other chiropractic services are not covered), all featuring no coinsurance.
Preventive Services See details
Preventive Services are covered by Humana Dual Select H5216-298 (PPO D-SNP) with no copay and no coinsurance, including annual physicals, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, but health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Dual Select H5216-298 (PPO D-SNP) covers hearing services, including Medicare-covered exams for a $50 copay and no coinsurance, as well as routine exams, fitting evaluations, and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, excluding inner ear, outer ear, and over the ear models which are not covered.
Vision Services See details
Humana Dual Select H5216-298 (PPO D-SNP) offers partially covered vision services, featuring one routine eye exam and one pair of eyeglasses or contact lenses per year with no copay, no coinsurance, and no deductible. An annual maximum benefit of $40 for exams and $300 for eyewear applies, while other eye exams, separate eyeglass lenses or frames, and upgrades are not covered.
Dental Services See details
Humana Dual Select H5216-298 (PPO D-SNP) partially covers dental services up to a $2,500 yearly limit, offering Medicare-covered dental services for a $50 copay and no coinsurance, and other covered dental services with no copay and no coinsurance. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Dual Select H5216-298 (PPO D-SNP) covers home infusion bundled services with prior authorization and step therapy. Covered Part B insulin carries a $35 copay, other Part B drugs have no copay, and chemotherapy or radiation drugs require a copay, with all of these services charging no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Humana Dual Select H5216-298 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered by Humana Dual Select H5216-298 (PPO D-SNP) with a 20% coinsurance and no copay for durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and diabetic supplies are limited to select manufacturers.
Diagnostic and Radiological Services See details
Humana Dual Select H5216-298 (PPO D-SNP) covers diagnostic and radiological services with prior authorization. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $50, while lab services and diagnostic radiological services have no copay. Therapeutic radiological services require a minimum 20% coinsurance and a minimum $50 copay, and outpatient X-rays require coinsurance with no copay.
Home Health Services See details
Humana Dual Select H5216-298 (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Dual Select H5216-298 (PPO D-SNP) provides cardiac rehabilitation services with no coinsurance and prior authorization, but only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Dual Select H5216-298 (PPO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Humana Dual Select H5216-298 (PPO D-SNP), excluding highly integrated services for dual eligible SNPs. Covered benefits include acupuncture for a $50 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance.
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