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Humana Dual Select H5216-385 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H5216-385 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Dual Select H5216-385 (PPO D-SNP) in 2025, please refer to our full plan details page.
Humana Dual Select H5216-385 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Michigan. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Dual Select H5216-385 (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:
Humana Dual Select H5216-385 (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 Humana Dual Select H5216-385 (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 Humana Dual Select H5216-385 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.60. 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 Humana Dual Select H5216-385 (PPO D-SNP) plan has a deductible of $590.00. After the deductible is met, you will pay costs for your drugs based on the tier and pharmacy you use. If you qualify for the low-income subsidy (LIS), the monthly premium for Part D is $26.60. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, and you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Dual Select H5216-385 (PPO D-SNP) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with coinsurance, and ambulance services with a copay. This plan also covers primary care visits with a copay, preventive services with no copay for annual physical exams, and hearing and vision services with varying copays and coinsurance. Dental services are covered with a copay for Medicare dental and other services with a $2,000 annual maximum. Additional benefits include home health services with no copay, skilled nursing facility stays with a copay after day 20, and coverage for other services like acupuncture and over-the-counter items. The plan also has coverage for emergency services, including worldwide emergency services, with a copay, and covers diagnostic and radiological services with a copay and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $595 for days 1-4 and no copay for days 5-90 for Inpatient Hospital-Acute, and a copay of $595 for days 1-3 and no copay for days 4-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. 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.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services with a 20% coinsurance and a $45 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Dual Select H5216-385 (PPO D-SNP) plan. The plan has a $55 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $315 copay. Transportation Services to a plan-approved health-related location are covered with no copay, up to 100 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by this plan. For Emergency Services, there is a $110 copay and no coinsurance. For Urgently Needed Services, there is a $45 copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay and no coinsurance.
Primary Care See details
The Humana Dual Select H5216-385 (PPO D-SNP) plan covers primary care physician services with a $5 copay, and chiropractic services with 20% coinsurance. Occupational therapy services have a $35 copay, while specialist visits have a $45 copay. Mental health and psychiatric individual and group sessions have a $45 copay, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $5 and $45, and Opioid Treatment Program Services have a coinsurance of 20% and a copay between $45.
Preventive Services See details
Preventive services are covered, including annual physical exams with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered, with some services potentially having a copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, routine hearing exams with no copay for up to 1 exam per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered; also, OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, and eyewear with a 20% coinsurance for contact lenses and no copay for eyeglasses. Routine eye exams have no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $45 copay, and other dental services with a $2,000 maximum benefit each year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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% and no copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Dual Select H5216-385 (PPO D-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, and radiological services, are covered. 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 $5 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Dual Select H5216-385 (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 the plan does not cover the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, or SET for PAD. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Dual Select H5216-385 (PPO D-SNP) plan. There is no copay for days 1-20, and a $214 copay for days 21-100, and additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Dual Select H5216-385 (PPO D-SNP) plan covers acupuncture with a $45 copay, up to 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $1200 per year. The plan also offers a meal benefit with no copay. Some services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others.
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