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HumanaChoice SNP-DE H5216-332 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-332 (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 H5216-332 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Louisiana. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-332 (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 H5216-332 (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 H5216-332 (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 H5216-332 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.90. 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:
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Drug Coverage
The HumanaChoice SNP-DE H5216-332 (PPO D-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using standard pharmacies or preferred mail order services. If you choose standard mail order, copays range from $10 to $20 for a one-month supply and $30 to $60 for a three-month supply depending on the drug tier. For higher-tier medications, this Medicare plan requires a 25% coinsurance instead of a flat copayment. This 25% coinsurance applies to Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs across standard pharmacies and mail order options. While Tier 3 and Tier 4 medications are available for both one-month and three-month supplies, Tier 5 specialty drugs are restricted to a one-month supply.
Additional Benefits
The HumanaChoice SNP-DE H5216-332 (PPO D-SNP) offers comprehensive medical coverage, featuring no copays for primary care, specialist visits, and home health services, though many outpatient services require a 20% coinsurance. For inpatient hospital care, members pay a $2,230 copay per acute stay with no copay for unlimited additional days, while skilled nursing facility stays feature no copay for the first 20 days. Emergency room visits require a $115 copay, which is waived upon admission, while ground ambulance services carry a $335 copay. Supplemental benefits include dental coverage with no copay and no coinsurance up to a $2,000 annual maximum, alongside a $150 annual allowance for eyewear with no copay. Members also benefit from hearing aid coverage, over-the-counter items, and chronic illness meals with no copay or coinsurance. Additionally, the plan covers up to 36 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) partially covers inpatient hospital services with no coinsurance and required prior authorization, charging a $2,230 copayment per acute stay and a $2,080 copayment per psychiatric stay. Unlimited additional acute days are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) covers outpatient hospital services with a $555 copay and 20% coinsurance, and ambulatory surgical center services with a $475 copay and 20% coinsurance. Outpatient substance abuse and blood services are also covered with no copay and 20% coinsurance, with prior authorization required for these outpatient benefits.
Partial Hospitalization See details
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HumanaChoice SNP-DE H5216-332 (PPO D-SNP), featuring a $335 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. The plan also includes up to 36 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) and 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 H5216-332 (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance. Chiropractic care is partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, and diabetes training. Select supplemental benefits like in-home support, memory fitness, and chemotherapy wigs (up to $500) are also covered with no copay and no coinsurance. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) covers hearing services with no deductible, offering routine hearing exams with no copay and 20% coinsurance, and fitting evaluations and over-the-counter 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, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by HumanaChoice SNP-DE H5216-332 (PPO D-SNP) with no deductible, though prior authorization is required. One routine eye exam is covered per year with no copay and 20% coinsurance up to a $75 limit, while covered eyewear includes one pair of contact lenses or eyeglasses (lenses and frames) annually with no copay and no coinsurance up to a $150 limit. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice SNP-DE H5216-332 (PPO D-SNP), offering Medicare-covered dental care with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $2,000 annual maximum. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) covers home infusion bundled services, requiring prior authorization and step therapy. Covered Part B insulin has a $35 copay and up to 20% coinsurance, chemotherapy and radiation drugs require a copay and up to 20% coinsurance, and other Part B drugs have no copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice SNP-DE H5216-332 (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 HumanaChoice SNP-DE H5216-332 (PPO D-SNP) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic services. 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 H5216-332 (PPO D-SNP) with prior authorization, generally requiring a 20% coinsurance. Under this plan, there is no copay for lab services, a $50 copay for outpatient X-rays, a minimum $200 copay for diagnostic radiological services, and applicable copays for diagnostic procedures and therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by HumanaChoice SNP-DE H5216-332 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the HumanaChoice SNP-DE H5216-332 (PPO D-SNP) plan. Although the overall benefit features no copay, specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HumanaChoice SNP-DE H5216-332 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered by HumanaChoice SNP-DE H5216-332 (PPO D-SNP) include 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. This benefit is partially covered, as it excludes some CMS-listed over-the-counter drugs, highly integrated dual eligible services, and other unspecified services.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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