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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 2026, 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 2026.
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 $1.40. 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:
Sign up for HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-370 (PPO D-SNP) features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. Once this deductible is met, you enter the initial coverage phase, where Tier 1 preferred generic drugs have no copay at standard pharmacies and preferred mail-order services. However, receiving these Tier 1 drugs through standard mail requires a $20.00 copay. 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 options. After your yearly out-of-pocket drug costs reach $2,100.00, you transition to the catastrophic coverage phase and pay nothing for covered Part D prescriptions. Additionally, if you qualify for the low-income subsidy, your Part D drug costs are reduced to $1.40.
Additional Benefits
The HumanaChoice SNP-DE H5216-370 (PPO D-SNP) offers comprehensive medical coverage, though cost-sharing applies to several key services. Inpatient hospital stays require a copay of $2,230 for acute care and $2,080 for psychiatric care, with no coinsurance. Most doctor, specialist, and therapy visits feature a 20% coinsurance with no copay, while emergency room visits require a $115 copay that is waived if you are admitted within 24 hours. This plan also includes valuable everyday benefits, such as routine dental care up to a $1,500 annual limit and routine vision eyewear up to a $150 limit, both with no copay or coinsurance. Additionally, members benefit from up to 36 one-way routine transportation trips, home health services, and over-the-counter items with no copay or coinsurance. Hearing exams and hearing aids are also covered with no copay, alongside up to 20% coinsurance for routine exams.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) partially covers inpatient hospital services, requiring a $2,230 copay per stay and no coinsurance for acute care, and a $2,080 copay per stay and no coinsurance for psychiatric care. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers outpatient services with a 20% coinsurance, featuring no copay for outpatient blood, observation, and substance abuse services. Outpatient hospital services require a $550 copay and 20% coinsurance, while ambulatory surgical center services require a $400 copay and 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice SNP-DE H5216-370 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these benefits.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers ambulance and transportation services, with ground ambulance requiring a $335 copay (no coinsurance) and air ambulance requiring a 20% coinsurance (no copay). Transportation benefits are partially covered, offering up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to a $40 maximum per visit) and no copay, while worldwide emergency, urgent, and transportation services each require a $115 copay and no coinsurance.
Primary Care See details
Primary Care benefits under HumanaChoice SNP-DE H5216-370 (PPO D-SNP) are covered, with most doctor, specialist, and therapy services requiring a 20% coinsurance and no copay. Routine chiropractic care (up to 12 visits per year) and Medicare-covered podiatry are available with no copay, though a 20% coinsurance applies to routine foot care and telehealth services.
Preventive Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits such as annual physical exams, glaucoma screenings, and kidney disease education. However, the plan does not cover health education, in-home safety assessments, PERS, MNT, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by HumanaChoice SNP-DE H5216-370 (PPO D-SNP), featuring fitting evaluations and OTC hearing aids with no copay or coinsurance, alongside routine exams with no copay and up to 20% coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two general aids every three years, while inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers annual routine eye exams with no copay and a 20% coinsurance, up to a $75 yearly limit. Eyewear is partially covered with no copay and no coinsurance up to a combined $150 annual limit, though eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice SNP-DE H5216-370 (PPO D-SNP), with fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require a 20% coinsurance and no copay, while other covered dental services have no copay and no coinsurance up to a $1,500 annual maximum for both in-network and out-of-network care.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers home infusion bundled services with prior authorization, featuring coinsurance ranging from no coinsurance to 20% on Part B drugs. Under this benefit, Medicare Part B insulin drugs have a $35 copay, other Part B drugs have no copay, and chemotherapy or radiation drugs require a copay.
Dialysis Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with prior authorization required. These covered benefits generally carry a 20% coinsurance and no copay, including no copay for diabetic therapeutic shoes and inserts.
Diagnostic and Radiological Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers diagnostic and radiological services with a 20% coinsurance and required prior authorization. Lab services feature no copay, outpatient x-rays require a $50 copay, and diagnostic radiological services have a copay ranging from $200 to $780.
Home Health Services See details
Home Health Services are covered by HumanaChoice SNP-DE H5216-370 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice SNP-DE H5216-370 (PPO D-SNP) plan. As a result, there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under HumanaChoice SNP-DE H5216-370 (PPO D-SNP) with no copay for days 1 to 20, a $218 daily copay for days 21 to 100, and no coinsurance. The benefit is partially covered, requiring prior authorization, and additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
HumanaChoice SNP-DE H5216-370 (PPO D-SNP) covers other services, including acupuncture with a 20% coinsurance and no copay, as well as over-the-counter items and meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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