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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 2025, 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 2025.
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 $47.30. 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 $14000.00 (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 $14000.00 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) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. If you qualify for the low-income subsidy (LIS), you will pay $47.30 for Part D. Once your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5216-367 (PPO D-SNP) plan offers a variety of benefits with varying cost-sharing. Inpatient hospital stays have a high copay, while many outpatient services, including primary care, preventive services, and home health services, have no copay. The plan also includes coverage for hearing, vision, and dental services, with specific cost-sharing details for each. Additionally, the plan offers coverage for ambulance services, emergency services, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Inpatient Hospital-Acute has a copay of $2185.00 per admission or per stay, and Inpatient Hospital Psychiatric has a copay of $2036.00 per admission or per stay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a 20% coinsurance and a $525 copay, while Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a $375 copay and at least a 20% coinsurance. Individual and group sessions for outpatient substance abuse have at least a 20% coinsurance. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, with a limit of 36 one-way trips per year. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Worldwide Emergency Coverage, the copay is $110.00 with no coinsurance, and for Urgently Needed Services, there is a 20% coinsurance with no copay.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Individual and Group Sessions for Mental Health Specialty Services, Individual and Group Sessions for Psychiatric Services, Opioid Treatment Program Services, and Additional Telehealth Benefits are covered with a 20% coinsurance. Chiropractic Services are covered with a 20% coinsurance, and Routine Chiropractic Care has no copay. Podiatry Services are covered with a 20% coinsurance, and Routine Foot Care is covered with a 20% coinsurance and no copay.
Preventive Services See details
The HumanaChoice SNP-DE H5216-367 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including wigs for hair loss related to chemotherapy and additional sessions of smoking and tobacco cessation counseling, are covered, but may require a copay and prior authorization. Kidney disease education services are covered with no copay. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are covered with no copay.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and no copay. Prescription hearing aids (all types) are covered with no copay, though prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The HumanaChoice SNP-DE H5216-367 (PPO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay. Eyewear is covered with no copay, and includes a combined maximum benefit of $250 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice SNP-DE H5216-367 (PPO D-SNP) plan covers Medicare dental services with 20% coinsurance. Other dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, are covered with no copay, and have various visit limits and periodicity. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs are covered with 0-20% coinsurance, and have no copay.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice SNP-DE H5216-367 (PPO D-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $500 and a coinsurance of at most 20%, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered 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 none of the specific services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice SNP-DE H5216-367 (PPO D-SNP) plan covers acupuncture with a 20% coinsurance, and a limit of 20 treatments per year. Over-the-counter (OTC) items are covered, including nicotine replacement therapy and naloxone, with a maximum benefit coverage amount of $2520 per year. The plan also covers a meal benefit with no copay.
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