A non-government entity
Humana Dual Select H5216-361 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H5216-361 (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 H5216-361 (PPO D-SNP) in 2026, please refer to our full plan details page.
Humana Dual Select H5216-361 (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 Arkansas. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Dual Select H5216-361 (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 H5216-361 (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 H5216-361 (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 H5216-361 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.10. 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 $9550.00 (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 $9550.00 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 Humana Dual Select H5216-361 (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Dual Select H5216-361 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615.00. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies and through preferred mail order. If you qualify for the low-income subsidy, your Part D cost is reduced to $4.10. For Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance at standard pharmacies and mail-order services. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for your covered Part D drugs. This structure ensures clear, predictable costs for your essential medications throughout the year.
Additional Benefits
The Humana Dual Select H5216-361 (PPO D-SNP) plan offers comprehensive medical coverage with affordable cost-sharing for essential services. You will pay no copay or coinsurance for primary care visits, preventive services, annual physicals, or home health care. For specialist visits, there is a $20 copay, while inpatient hospital stays require a $325 daily copay for the first six days and no copay for days 7 through 90. This plan also includes valuable everyday benefits to support your overall well-being. Routine dental, vision, and hearing exams are covered with no copay, and you will pay nothing for covered eyewear, prescription hearing aids, and up to 36 one-way non-emergency trips per year. Additionally, members can access over-the-counter items and meal benefits with no copay or coinsurance.
Inpatient Hospital See details
Humana Dual Select H5216-361 (PPO D-SNP) partially covers inpatient hospital services, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90 for both acute and psychiatric stays, with no coinsurance. While additional acute care days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by Humana Dual Select H5216-361 (PPO D-SNP) include outpatient hospital care with a 20% coinsurance and a copay ranging from no copay to $370. Other benefits like ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $30 to $35 copay and observation services require a $325 copay per stay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Dual Select H5216-361 (PPO D-SNP) with a $35 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Humana Dual Select H5216-361 (PPO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Dual Select H5216-361 (PPO D-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Primary Care benefits offered by Humana Dual Select H5216-361 (PPO D-SNP) feature no copay and no coinsurance for primary care visits, while specialist visits require a $20 copay and no coinsurance. Therapy, mental health, and psychiatric services have copays ranging from $15 to $30 with no coinsurance, but chiropractic services are only partially covered—excluding routine care—and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by Humana Dual Select H5216-361 (PPO D-SNP) with no copay and no coinsurance for covered benefits like annual physical exams and fitness programs. Non-covered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Dual Select H5216-361 (PPO D-SNP) covers hearing exams with a $20 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine annual exams, fittings, and OTC hearing aids. Prescription hearing aids are partially covered with no copay or coinsurance for up to two general devices every three years, but inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision Services are partially covered by Humana Dual Select H5216-361 (PPO D-SNP), offering eye exams with a $0 to $20 copay and covered eyewear with no copay, both with no coinsurance or deductibles. Routine eye exams, contact lenses, and complete eyeglasses are covered, while separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services under Humana Dual Select H5216-361 (PPO D-SNP) are partially covered, with Medicare-covered dental requiring a $20 copay and no coinsurance. Most other covered preventive and comprehensive services have no copay and no coinsurance up to a $1,500 annual limit, though fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Humana Dual Select H5216-361 (PPO D-SNP) and require prior authorization, with coinsurance ranging from no coinsurance to 20% for Medicare Part B drugs. Part B insulin drugs have a $35 copay, while other Part B drugs carry no copay.
Dialysis Services See details
Humana Dual Select H5216-361 (PPO D-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required before receiving these covered services.
Medical Equipment See details
Humana Dual Select H5216-361 (PPO D-SNP) covers durable medical equipment, prosthetic devices, and diabetic supplies 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 under Humana Dual Select H5216-361 (PPO D-SNP) with prior authorization, featuring no copay or coinsurance for lab and outpatient x-ray services. Diagnostic procedures require a copay of up to $50 with no coinsurance, while diagnostic radiological services carry a copay of up to $300 and 20% coinsurance. Therapeutic radiological services have a 20% coinsurance and no copay.
Home Health Services See details
Humana Dual Select H5216-361 (PPO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Humana Dual Select H5216-361 (PPO D-SNP) indicates that some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Since these services are not covered, there is no copay or coinsurance coverage available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Dual Select H5216-361 (PPO D-SNP) with a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 100, and no coinsurance, though prior authorization is required. Additional days beyond those covered by Medicare are not covered by the plan.
Other Services See details
Other Services covered by Humana Dual Select H5216-361 (PPO D-SNP) include acupuncture for a $20 copay and no coinsurance, as well as meal benefits and over-the-counter items with no copay and no coinsurance. Dual Eligible SNPs with highly integrated services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved