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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 2025, 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 2025.
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 $21.30. 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 $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 HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs in each 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, where you will pay nothing for your Medicare Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $21.30.
Additional Benefits
The HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, as well as outpatient services with 20% coinsurance. Primary care, preventive services, hearing, vision, and dental services are included, often with no copay for exams and certain services, and coinsurance for others. This plan also covers ambulance and transportation, emergency services, and home health services with no copay. Additional benefits include coverage for medical equipment, diagnostic services, and skilled nursing facility stays.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan. Acute inpatient hospital stays have a copay of $2,185 per admission or stay, and psychiatric stays have a copay of $2,036 per admission or stay; additional days for acute inpatient hospital stays are covered with no copay, while other sub-services are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by this plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a minimum and maximum coinsurance of 20%. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to plan-approved health-related locations have no copay and are limited to 30 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $110 copay, and Urgently Needed Services has a 20% coinsurance, but there is no coinsurance for Emergency Services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
The HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, all with 20% coinsurance. Routine Chiropractic Care is not covered. For Medicare-covered podiatry services, there is no copay and 20% coinsurance.
Preventive Services See details
The HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, are covered with no copay, and other services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered by the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan, with a coinsurance of at most 20% for routine hearing exams and no copay for fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with no copay for prescription hearing aids (all types) but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with no copay and 20% coinsurance, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services have a maximum benefit of $1500 per year, and some services have no copay including oral exams (3 per year), dental x-rays (3 per year), other diagnostic dental services (1 every three years), prophylaxis (cleaning) (2 per year), and other preventive dental services (4 per year). Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. Other Medicare Part B Drugs have no copay, and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered under this plan. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance with no copay. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered by the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have a $0 copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at most $300 and a coinsurance of at most 20%, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The HumanaChoice SNP-DE H5216-302 (PPO D-SNP) plan covers acupuncture with a 20% coinsurance, up to 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $1200 per year. The plan offers a meal benefit with no copay, and other services are not covered.
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