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HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida SNP-DE H5216-394 (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 Florida SNP-DE H5216-394 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Central and North Florida. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Florida SNP-DE H5216-394 (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 Florida SNP-DE H5216-394 (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 Florida SNP-DE H5216-394 (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 Florida SNP-DE H5216-394 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.30. 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 $8950.00 (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 $8950.00 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 Florida SNP-DE H5216-394 (PPO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $20.30. During the initial coverage phase, after you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) plan offers comprehensive coverage, including no copays for many services like primary care, preventive services, and home health. This plan also covers inpatient hospital stays with a $1,000 copay per admission, outpatient services with a 20% coinsurance, and emergency services with a $90 copay. Additional benefits include coverage for hearing and vision services, with no copays for routine exams and hearing aids up to a certain amount. Dental services are also covered with no copay for a range of services, up to an annual maximum. The plan also covers medical equipment, diagnostic services, and other services like acupuncture and OTC items with a monthly benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $1,000 per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a 20% coinsurance and no copay, observation services with a 20% coinsurance, and ambulatory surgical center services with a 20% coinsurance and no copay. Outpatient substance abuse services include individual and group sessions with a 20% coinsurance and no copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with 20% coinsurance for both ground and air ambulance services, and no copay for transportation services to plan-approved health-related locations. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Urgently Needed Services have a $40 copay, and there is no coinsurance for any of these services.
Primary Care See details
The HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) plan offers a range of primary care services with no copay, including Primary Care Physician Services, Physician Specialist Services, Individual and Group Sessions for Mental Health and Psychiatric Services. Chiropractic and Occupational Therapy Services are covered with a $0 copay. Physical Therapy and Speech-Language Pathology Services have no copay, but a 20% coinsurance applies. Additionally, Additional Telehealth Benefits are available with a copay between $0 and $40. Opioid Treatment Program Services are covered with a 20% coinsurance and a $0 copay. However, Routine Chiropractic Care is not covered, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services, with a copay for some services. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to a maximum of $3600 every three years, and OTC hearing aids are covered with 25% coinsurance.
Vision Services See details
Vision services include eye exams and eyewear, with routine eye exams, contact lenses, and eyeglasses (lenses and frames) covered with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include Medicare Dental Services with no copay, other dental services with a $2,000 maximum benefit per 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 fixed), and oral and maxillofacial surgery, all with no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
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 with a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices also have a 20% coinsurance; Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a coinsurance of up to 20% for Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Lab Services have a coinsurance of up to 20% and no copay, while Diagnostic Procedures/Tests have a maximum copay of $40.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Florida SNP-DE H5216-394 (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 by the HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) plan, but the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Florida SNP-DE H5216-394 (PPO D-SNP) plan, with a $0 copay for days 1-20 and a $185.50 copay for days 21-100, though additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services include acupuncture with no copay and OTC items with a $35 monthly maximum benefit, as well as a meal benefit with no copay. 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, and Self-Directed Personal Assistance Services are not covered.
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