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HumanaChoice SNP-DE H5216-377 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-377 (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 H5216-377 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-377 (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 Maryland. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5216-377 (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 H5216-377 (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 H5216-377 (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 H5216-377 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.50. 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 $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 H5216-377 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2,000, you enter the next coverage phase. If you qualify for the low-income subsidy, the Part D premium is $36.50.
Additional Benefits
The HumanaChoice SNP-DE H5216-377 (PPO D-SNP) plan offers comprehensive coverage with a focus on managing costs. Inpatient hospital stays have a $1880 copay per admission, while outpatient services have varying copays and coinsurance. Emergency services range from $45 to $110. The plan emphasizes preventive care, with no copay for annual physical exams, and other services. Additionally, it includes coverage for hearing and vision services, as well as dental services. Other covered services include ambulance, home health, and skilled nursing facility, with varying cost structures.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered, but require prior authorization. You will have a copay of $1880 per admission or stay for Medicare-covered inpatient hospital stays, and additional days for inpatient hospital-acute are covered with no copay.
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 services with a $200 copay and at least 20% coinsurance, outpatient substance abuse services with at least 20% coinsurance for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice SNP-DE H5216-377 (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $315 copay, and transportation services to plan-approved health-related locations have no copay for up to 36 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay; Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits include coverage for primary care physician services, chiropractic services (routine care not covered), occupational therapy services, physician specialist services, mental health specialty services (individual and group sessions), other health care professional services, psychiatric services (individual and group sessions), physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. For most services, you will pay 20% coinsurance, and additional telehealth benefits have a copay between $0 and $45.
Preventive Services See details
The HumanaChoice SNP-DE H5216-377 (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 have a copay. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a Welcome Visit, all with no copay. Health education, in-home safety assessments, personal emergency response systems, 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 benefits, home-based palliative care, in-home support services, support for caregivers, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, 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 fitting/evaluation for hearing aids has no copay. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice SNP-DE H5216-377 (PPO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, and other dental services with a maximum benefit of $4,000 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, though fluoride treatment and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice SNP-DE H5216-377 (PPO D-SNP) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with an 18% coinsurance and Prosthetics/Medical Supplies with 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
The HumanaChoice SNP-DE H5216-377 (PPO D-SNP) plan covers Diagnostic and Radiological 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 by the HumanaChoice SNP-DE H5216-377 (PPO D-SNP) plan 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 the plan does not cover the following: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the HumanaChoice SNP-DE H5216-377 (PPO D-SNP) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The HumanaChoice SNP-DE H5216-377 (PPO D-SNP) plan covers acupuncture with a 20% coinsurance after prior authorization. Over-the-counter (OTC) items are covered up to $1200 per year, and the plan also covers a meal benefit with no copay after prior authorization. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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, or Self-Directed Personal Assistance Services.
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