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HumanaChoice SNP-DE H5216-302 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-302 (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 H5216-302 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-302 (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 Nevada. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-302 (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 H5216-302 (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 H5216-302 (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 H5216-302 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $9.50. 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 H5216-302 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-302 (PPO D-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using standard pharmacies or preferred mail order services. However, standard mail order services incur copays ranging from $10 to $30 for Tier 1 drugs and $20 to $60 for Tier 2 drugs. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance across standard pharmacies and mail order options. This 25% coinsurance applies to both 1-month and 3-month supplies for Tiers 3 and 4, as well as 1-month supplies for Tier 5 specialty medications. These clear cost-sharing tiers help you easily project your prescription drug expenses with this HumanaChoice plan.
Additional Benefits
The HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan offers robust medical coverage with no copay and a 20% coinsurance for primary care, specialist visits, and outpatient hospital services. Inpatient hospital stays require a $1,760 copay per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Routine preventive care, home health services, and chronic illness meals are fully covered with no copay and no coinsurance. Ancillary benefits include comprehensive dental coverage up to a $2,500 annual limit and a $400 annual limit for eyewear, both featuring no copay and no coinsurance for covered services. Members also benefit from up to 36 free one-way transportation trips per year, alongside routine hearing and vision exams that feature no copay. Other key services, such as durable medical equipment, dialysis, and lab tests, generally require no copay and a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) inpatient hospital benefits are partially covered, requiring a $1,760 copay per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) covers outpatient services—including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for these services, and the deductible is waived for your first three pints of blood.
Partial Hospitalization See details
Partial hospitalization services are covered under the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan, with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-302 (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 20% coinsurance (up to a $40 maximum) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care services under the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan, including specialist visits, mental health, and physical therapies, are covered with no copay and 20% coinsurance. Chiropractic services are not covered, and routine podiatry care is limited to 12 visits per year with 20% coinsurance.
Preventive Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) partially covers preventive services with no copay and no coinsurance for covered benefits, which include annual physical exams, memory fitness, kidney disease education, and select screenings. Supplemental services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and home-based palliative care.
Hearing Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) covers hearing services with no deductible, offering Medicare-covered exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Routine exams are limited to one per year with no copay and a 20% coinsurance, while prescription hearing aids are partially covered with no copay or coinsurance for up to two aids every three years, excluding inner ear, outer ear, and over-the-ear models.
Vision Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) covers one routine eye exam per year with no copay and 20% coinsurance up to a $40 limit, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 annual limit for one pair of contact lenses or eyeglasses (lenses and frames), though individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) offers partially covered dental services with no copay and 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,500 annual limit. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) covers Home Infusion bundled Services with prior authorization, requiring a 0% to 20% coinsurance for most Medicare Part B drugs. Under this benefit, Medicare Part B insulin has a $35 copay, other Part B drugs have no copay, and chemotherapy or radiation drugs require a copay alongside the 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment covered by HumanaChoice SNP-DE H5216-302 (PPO D-SNP) includes durable medical equipment, prosthetics, medical supplies, and diabetic services 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 H5216-302 (PPO D-SNP) with prior authorization, subject to a 20% coinsurance. Diagnostic procedures and lab services have no copay, whereas diagnostic radiological services require a $200 copay.
Home Health Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) covers Cardiac Rehabilitation Services with no copay, though prior authorization is required and only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, without requiring a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice SNP-DE H5216-302 (PPO D-SNP) provides acupuncture with no copay and 20% coinsurance for up to 20 treatments annually, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Highly integrated services for dual eligibles and other additional services are not covered.
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