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HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-370 (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 H5216-370 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Alabama. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-370 (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 H5216-370 (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 H5216-370 (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 H5216-370 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.10. 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 $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 H5216-370 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with coinsurance, and emergency services with a copay. You'll also find coverage for primary care, hearing, vision, and dental services, with varying copays and coinsurance amounts. The plan also covers home health, skilled nursing, and other services like acupuncture and an over-the-counter items benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $2185.00 per admission or stay, and additional days are covered with no copay. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $2036.00 per admission or stay, and additional days are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a 20% coinsurance and a $550 copay, observation services with a 20% coinsurance, Ambulatory Surgical Center (ASC) services with a $400 copay and a 20% coinsurance, and outpatient substance abuse services with a 20% coinsurance for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 36 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $110 copay, and Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Routine Chiropractic Care and Additional Telehealth Benefits have no copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance. Routine Foot Care has a 20% coinsurance and no copay. Other services have a 20% coinsurance, and some require prior authorization.
Preventive Services See details
Preventive Services are covered by the HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan, with no copay for annual physical exams and additional preventive services, including wigs for hair loss related to chemotherapy and additional sessions of smoking and tobacco cessation counseling. Other preventive services like Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams, and a copay for Medicare-covered benefits and hearing aid fittings/evaluations. Prescription hearing aids (all types) are covered with no copay.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, as well as eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services with a $1,500 annual maximum benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Fluoride treatments, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs, and Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is no copay, with a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan and require prior authorization. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a coinsurance of at most 20%, and lab services with no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at most $720 and a coinsurance of at most 20%, while 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 by the HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan. Prior authorization is required for the services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered SNF stays are not covered.
Other Services See details
The HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan covers acupuncture with 20% coinsurance, and also offers an Over-the-Counter (OTC) Items benefit with a maximum coverage amount of $2100 per year. The plan also offers a meal benefit with no copay. However, 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 are not covered.
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