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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 2025, 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 AR. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $20.90. 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 $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 $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:
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Drug Coverage
The Humana Dual Select H5216-361 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you'll pay the costs for your drugs in each tier until your total drug costs reach $2000. This plan's premium is $20.90 if you qualify for the low-income subsidy. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs. Please check the plan’s formulary for specific drugs covered.
Additional Benefits
The Humana Dual Select H5216-361 (PPO D-SNP) plan offers a variety of benefits, including inpatient and outpatient hospital care with varying copays and coinsurance, as well as coverage for emergency services, primary care, and preventive services with no copay. The plan also includes coverage for hearing, vision, and dental services, with a $1,000 annual maximum for dental. Additional benefits include coverage for home health services with no copay, and ambulance services with a copay. This plan also offers coverage for medical equipment, and diagnostic and radiological services, with varying copays and coinsurance depending on the service. Other covered services include acupuncture, OTC items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care, with a copay of $325 for days 1-6 and no copay for days 7-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $100-$370 copay and 20% coinsurance, observation services with a $325 copay, ambulatory surgical center services with a $310 copay and 20% coinsurance, outpatient substance abuse services with a $40-$100 copay for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for these services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Dual Select H5216-361 (PPO D-SNP) plan. Ground and air ambulance services have a copay of $315, while transportation services to a plan-approved health-related location have no copay and are limited to 36 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Dual Select H5216-361 (PPO D-SNP) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Dual Select H5216-361 (PPO D-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, while occupational therapy and physical therapy services have a $15 copay. Physician specialist services have a $20 copay. Mental health and psychiatric individual and group sessions have a $40 copay. Additional telehealth benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a copay between $40 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Dual Select H5216-361 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are not covered, while kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum benefit of $500 per ear every year, and OTC hearing aids are covered with no copay, up to $500 per ear every year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Humana Dual Select H5216-361 (PPO D-SNP) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered with a $1,000 annual maximum benefit. Medicare dental services have a $20 copay, while other dental services have no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, fixed, and oral and maxillofacial surgery; 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 under this plan. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%, while Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have no copay and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Dual Select H5216-361 (PPO D-SNP) plan. There is a 20% coinsurance for dialysis services, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Diabetic Supplies have a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance. There is no copay for DME and Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $55, Lab Services with no copay, and Diagnostic Radiological Services with a coinsurance of at most 20% and a copay of at most $325. Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Dual Select H5216-361 (PPO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and the copay information is listed below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Dual Select H5216-361 (PPO D-SNP) plan covers acupuncture with a $20 copay, up to 20 treatments per year, and requires prior authorization. Over-the-counter (OTC) items are also covered, with a maximum benefit of $1200 per year. The plan also offers a meal benefit with no copay, for a chronic illness, but does not cover the following services: Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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