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HumanaChoice SNP-DE H5216-373 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-373 (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 H5216-373 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-373 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Greater Philadelphia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-373 (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 H5216-373 (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 H5216-373 (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 H5216-373 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.40. 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 $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 H5216-373 (PPO D-SNP) plan has a $590.00 deductible for prescription drugs. After meeting the deductible, you will pay the costs for your drugs, but the specific costs for each tier are not provided. Once your total drug costs reach $2000.00, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5216-373 (PPO D-SNP) plan offers coverage for a wide range of services, including inpatient and outpatient hospital care, with varying copays and coinsurance. Emergency, primary care, preventive, and home health services are also included, some with no copay. This plan provides additional benefits such as hearing, vision, and dental services, with copays and coinsurance depending on the specific service. Other covered services include ambulance, transportation, and medical equipment, as well as some specialized services like dialysis and skilled nursing facilities, which may require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a copay of $2,185 per admission, and additional days have no copay. Inpatient Hospital Psychiatric has a copay of $2,036 per admission.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $250 copay and 20% coinsurance, Observation Services with a $500 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay and 20% coinsurance, and both Individual and Group Sessions for Outpatient Substance Abuse with 20% coinsurance. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. You pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $315 copay for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are covered with no copay, up to 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice SNP-DE H5216-373 (PPO D-SNP) plan. Emergency Services have a $110 copay, and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance; Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. For most services, you will pay 20% coinsurance, and some telehealth services have a copay between $0 and $45. Chiropractic Services excludes coverage for Routine Care, and Podiatry Services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services. Additional preventive services include Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, and Support for Caregivers of Enrollees, which are not covered. Additionally, the plan covers Additional Sessions of Smoking and Tobacco Cessation Counseling and the Fitness Benefit, both with no copay. The plan also covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids has no copay; prescription hearing aids are covered with no copay for all types, but hearing aids for the inner, outer, and over-the-ear are not covered; OTC hearing aids are covered up to $175 every three months.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, and you are allowed 1 pair per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a 20% coinsurance. Other dental services are covered up to a maximum of $4000 per year, including oral exams, dental x-rays, and other diagnostic and preventive dental services with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%, with no copay.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5216-373 (PPO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with 18% coinsurance for Durable Medical Equipment. Prosthetic Devices have 20% coinsurance, and Medical Supplies also have 20% coinsurance. Diabetic Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a copay of up to $45 and a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of up to $325 and a coinsurance of at most 20%, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $45 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the HumanaChoice SNP-DE H5216-373 (PPO D-SNP) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The HumanaChoice SNP-DE H5216-373 (PPO D-SNP) plan covers acupuncture with a 20% coinsurance and a limit of 20 treatments per year, and over-the-counter (OTC) items up to $175 every three months. The plan also offers a meal benefit with no copay. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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