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HumanaChoice SNP-DE H5216-367 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-367 (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 H5216-367 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-367 (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 Mississippi. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-367 (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 H5216-367 (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 H5216-367 (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 H5216-367 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.50. 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 H5216-367 (PPO D-SNP) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generic drugs, members enjoy no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order delivery for these generic tiers requires a copay of $10 to $20 for a one-month supply and $30 to $60 for a three-month supply. For Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, members must pay a 25% coinsurance. This 25% coinsurance rate applies across standard pharmacies, preferred mail order, and standard mail order options. This cost-sharing structure helps you easily estimate your out-of-pocket prescription costs based on your specific medication tier.
Additional Benefits
The HumanaChoice SNP-DE H5216-367 (PPO D-SNP) provides comprehensive healthcare coverage with no copay for primary care, specialist visits, preventive care, and home health services, though a 20% coinsurance applies to most of these medical visits. For more intensive care, inpatient hospital acute stays require a $2,230 copay, while outpatient hospital visits carry a $525 copay and a 20% coinsurance. Emergency room visits require a $115 copay, which is waived if you are admitted within 24 hours. Supplemental benefits are a key feature of this plan, offering preventive and comprehensive dental care with no copay or coinsurance up to a $2,000 annual limit. Routine eye exams require a 20% coinsurance with no copay, and you receive up to a $250 annual allowance for eyewear with no copay or coinsurance. Additionally, the plan covers up to 36 one-way transportation trips, over-the-counter items, and chronic illness meals, all with no copay or coinsurance.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) partially covers inpatient hospital services, requiring prior authorization and no coinsurance for all covered stays. Medicare-covered acute stays require a $2,230 copayment per admission with unlimited additional days at no copay, while psychiatric stays require a $2,080 copayment per admission; upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) covers outpatient services, featuring a $525 copay and 20% coinsurance for outpatient hospital services and a $375 copay and 20% coinsurance for ambulatory surgical center services. Outpatient substance abuse and blood services have no copay but require 20% coinsurance, with prior authorization required for most of these covered benefits.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice SNP-DE H5216-367 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require 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 H5216-367 (PPO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and 20% coinsurance, with prior authorization required for most services. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and select screenings. Prior authorization is required for some services, and wigs for hair loss are covered up to $500 annually with no copay. Sub-services that are not covered under this plan include Health Education, In-Home Safety Assessments, PERS, Medical Nutrition Therapy, Post-discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management, Alternative Therapies, Therapeutic Massage, Adult Day Health, Nutritional/Dietary benefits, Home-Based Palliative Care, Support for Caregivers, Enhanced Disease Management, Telemonitoring, Remote Access Technologies, Home and Bathroom Safety Modifications, and Counseling.
Hearing Services See details
Hearing services are covered by HumanaChoice SNP-DE H5216-367 (PPO D-SNP) with no deductible, offering routine exams for a 20% coinsurance and no copay, and fitting evaluations and OTC 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 models are not covered.
Vision Services See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) offers partially covered vision services, featuring routine eye exams with no copay and 20% coinsurance up to a $75 annual limit, while other eye exams are not covered. Covered eyewear, including contact lenses and eyeglasses, has no copay and no coinsurance up to a $250 yearly limit, but separate frames, lenses, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice SNP-DE H5216-367 (PPO D-SNP) with up to a $2,000 annual maximum benefit for combined in- and out-of-network care. Medicare-covered dental services have no copay and a 20% coinsurance, while other covered preventive and comprehensive services feature no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) covers Home Infusion bundled Services with prior authorization, offering insulin at a $35 copay and 0% to 20% coinsurance. Other covered Medicare Part B drugs, including chemotherapy and radiation medications, require no copay and feature 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, and prior authorization is required for most medical equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice SNP-DE H5216-367 (PPO D-SNP) subject to prior authorization and a 20% coinsurance. Lab services require no copay, while outpatient X-rays require a $50 copay, diagnostic radiological services have a minimum copay of $200, and other diagnostic and therapeutic services also require copayments.
Home Health Services See details
Home Health Services are covered by HumanaChoice SNP-DE H5216-367 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by HumanaChoice SNP-DE H5216-367 (PPO D-SNP) with no copay, but only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice SNP-DE H5216-367 (PPO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and while a 3-day inpatient hospital stay is not required prior to admission, additional days beyond the standard Medicare limit are not covered.
Other Services See details
HumanaChoice SNP-DE H5216-367 (PPO D-SNP) covers acupuncture with no copay and 20% coinsurance for up to 20 treatments per year, subject to prior authorization. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance.
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