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HumanaChoice SNP-DE H5216-331 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-331 (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 H5216-331 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-331 (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 Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-331 (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 H5216-331 (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 H5216-331 (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 H5216-331 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.90. 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 H5216-331 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-331 (PPO D-SNP) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. If you utilize standard mail order for these generic tiers, copays range from $10 to $20 for a one-month supply and $30 to $60 for a three-month supply. For higher-tier medications, including Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order for both one-month and three-month supplies, except for Tier 5 specialty drugs which are limited to a one-month supply.
Additional Benefits
The HumanaChoice SNP-DE H5216-331 (PPO D-SNP) plan offers comprehensive coverage with no copays or coinsurance for preventive care, home health services, and routine dental benefits up to a $2,000 annual limit. Beneficiaries can also take advantage of routine vision and hearing services, as well as over-the-counter items, with no copay and low out-of-pocket costs. For primary care, specialist visits, and outpatient hospital services, members generally pay no copay and a 20% coinsurance. For major medical needs, inpatient acute hospital stays require a $2,230 copay per stay, while psychiatric stays require a $2,080 copay. Emergency room visits have a $115 copay that is waived upon admission, whereas ambulance services and medical equipment require a 20% coinsurance and no copay. Additionally, skilled nursing facility stays feature no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) 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. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
The HumanaChoice SNP-DE H5216-331 (PPO D-SNP) plan covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, while transportation benefits are partially covered with no copay or coinsurance. Up to 36 one-way trips per year to plan-approved locations are covered, but transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a 20% coinsurance (up to $40 per visit) with no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) covers primary care, specialist, outpatient therapy, and mental health services with no copay and a 20% coinsurance. Chiropractic benefits are partially covered, excluding routine and other chiropractic care, while podiatry services are not covered.
Preventive Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and diabetes training, with no copay and no coinsurance. Additional preventive services are partially covered with no coinsurance, offering a fitness benefit with no copay, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by HumanaChoice SNP-DE H5216-331 (PPO D-SNP), featuring no copay and a 20% coinsurance for annual routine exams, and no copay or coinsurance for fitting evaluations and OTC hearing aids. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) provides partially covered vision services with no deductible, featuring no copay and a 20% coinsurance for routine eye exams up to a $40 annual limit, and no copay and no coinsurance for eyewear up to a $500 annual limit. Covered benefits include one routine eye exam and one pair of eyeglasses or contact lenses per year, while other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a $2,000 annual limit, while Medicare-covered dental has no copay and a 20% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) covers home infusion bundled services, which require prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, chemotherapy drugs require a copay and no coinsurance to 20% coinsurance, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice SNP-DE H5216-331 (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 benefits under HumanaChoice SNP-DE H5216-331 (PPO D-SNP) are covered with 20% coinsurance and no copay, with prior authorization required. Covered items include durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment, with diabetic supplies limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice SNP-DE H5216-331 (PPO D-SNP) with a 20% coinsurance and prior authorization required. Diagnostic tests and lab services have no copay, while outpatient X-rays carry a $50 copay and diagnostic radiological services also require a copayment.
Home Health Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization required, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice SNP-DE H5216-331 (PPO D-SNP) features partially covered other services, including acupuncture with no copay and 20% coinsurance, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. However, highly integrated dual-eligible SNP services and other miscellaneous services (Other 1, Other 2, and Other 3) are not covered.
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