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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 2026, 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 2026.
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 $8.80. 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:
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Drug Coverage
The Humana Dual Select H5216-385 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay at standard pharmacies and through preferred mail order services for both 1-month and 3-month supplies. Standard mail order options are also available, with Tier 1 copays ranging from $10 to $30 and Tier 2 copays ranging from $20 to $60. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, members are responsible for a 25% coinsurance. This 25% coinsurance rate applies consistently across standard pharmacies, preferred mail order, and standard mail order channels. These clear cost-sharing tiers help you easily estimate your out-of-pocket expenses for brand-name and specialty prescriptions under this plan.
Additional Benefits
The Humana Dual Select H5216-385 (PPO D-SNP) plan offers comprehensive coverage with no copay for primary care visits, home health services, and routine preventive care. For specialist visits, members pay a $45 copay, while inpatient acute hospital stays require a $595 daily copay for the first four days before transitioning to no copay. Emergency room visits carry a $115 copay, which is waived if you are admitted, and urgent care is available for a $40 copay. This plan also features robust supplemental benefits, including dental coverage up to a $2,000 annual limit and routine vision and hearing exams with no copay. Prescription hearing aids and eyeglasses are covered with no copay, alongside up to 100 free one-way transportation trips per year to plan-approved locations. Medical equipment and dialysis require a 20% coinsurance with no copay, while diagnostic services generally carry a 19% to 20% coinsurance.
Inpatient Hospital See details
Humana Dual Select H5216-385 (PPO D-SNP) partially covers inpatient hospital services, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Covered acute and psychiatric stays have no coinsurance, but they require a $595 daily copay for the first 4 days of an acute stay (no copay for days 5 and beyond) and a $595 daily copay for the first 3 days of a psychiatric stay (no copay for days 4 to 90).
Outpatient Services See details
Humana Dual Select H5216-385 (PPO D-SNP) covers outpatient services, offering outpatient hospital care with a $0 to $35 copay and 20% coinsurance, and ambulatory surgical center services with no copay and 20% coinsurance. Outpatient substance abuse services require a $35 copay with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Humana Dual Select H5216-385 (PPO D-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Dual Select H5216-385 (PPO D-SNP), featuring a $335 copay and no coinsurance for ground or air ambulance trips. The plan also covers up to 100 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under the Humana Dual Select H5216-385 (PPO D-SNP) plan are covered with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Dual Select H5216-385 (PPO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapy, as well as mental health sessions, have a $35 copay and no coinsurance, but podiatry is not covered, and chiropractic benefits show some services are covered though routine and other chiropractic care are not.
Preventive Services See details
Humana Dual Select H5216-385 (PPO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered options such as annual physicals, kidney disease education, and glaucoma screenings. However, sub-services like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access technologies, safety devices, and counseling are not covered.
Hearing Services See details
Humana Dual Select H5216-385 (PPO D-SNP) covers hearing services with no deductible, offering routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two devices every three years, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Dual Select H5216-385 (PPO D-SNP) partially covers vision services, offering routine eye exams and eyeglasses (lenses and frames) with no copay and no coinsurance, alongside contact lenses with no copay and 20% coinsurance up to a $550 annual limit. There are no deductibles, but other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Dual Select H5216-385 (PPO D-SNP) up to a $2,000 annual maximum for both in-network and out-of-network care. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance. Fluoride treatments, implants, orthodontics, fixed prosthodontics, and maxillofacial prosthetics are not covered under this plan.
Home Infusion bundled Services See details
Humana Dual Select H5216-385 (PPO D-SNP) covers home infusion bundled services with prior authorization, featuring up to 20% coinsurance for chemotherapy, radiation, insulin, and other Part B drugs. There is no copay for other Part B drugs, while insulin has a $35 copay, and step therapy may apply.
Dialysis Services See details
Dialysis services are covered by Humana Dual Select H5216-385 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment benefits are covered by Humana Dual Select H5216-385 (PPO D-SNP) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic supplies. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Dual Select H5216-385 (PPO D-SNP) covers diagnostic and radiological services with prior authorization, generally requiring a 19% to 20% coinsurance. Diagnostic procedures and tests have a copay ranging from $0 to $45, while lab services, outpatient X-rays, and diagnostic radiological services require no copay.
Home Health Services See details
Home health services are covered by Humana Dual Select H5216-385 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Dual Select H5216-385 (PPO D-SNP) offers coverage for some Cardiac Rehabilitation Services with no copay, though prior authorization is required. However, specific sub-services including standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Dual Select H5216-385 (PPO D-SNP) partially covers skilled nursing facility (SNF) care with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Dual Select H5216-385 (PPO D-SNP) provides partial coverage for other services, including acupuncture for a $45 copay and no coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Highly integrated dual eligible services and other additional unspecified services are not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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