A non-government entity
HumanaChoice SNP-DE H5216-468 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-468 (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 H5216-468 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-468 (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 H5216-468 (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 H5216-468 (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 H5216-468 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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:
Sign up for HumanaChoice SNP-DE H5216-468 (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice SNP-DE H5216-468 (PPO D-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic prescription drugs, you will pay no copay when filling your prescriptions at standard pharmacies or through preferred mail order. If you utilize standard mail order, your copay ranges from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, you will pay a 25% coinsurance at standard pharmacies, preferred mail order, and standard mail order. This 25% coinsurance applies to 1-month and 3-month supplies for Tiers 3 and 4, and 1-month supplies for Tier 5 medications.
Additional Benefits
The HumanaChoice SNP-DE H5216-468 (PPO D-SNP) offers comprehensive medical coverage with affordable cost-sharing structures for key healthcare services. For inpatient hospital stays, members pay an $1,800 copay per stay with no coinsurance, while outpatient care, primary care visits, and diagnostic services generally feature no copay and a 20% coinsurance. Emergency room visits require a $115 copay, which is waived upon hospital admission, and urgently needed services are covered with no copay and a 20% coinsurance capped at $40. This plan also provides robust supplemental benefits, including preventive care, home health services, and up to $4,000 in annual dental coverage with no copay and no coinsurance. Vision and hearing services also require no copay, offering a $350 annual allowance for eyewear and coverage for up to two hearing aids every three years. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100 with no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HumanaChoice SNP-DE H5216-468 (PPO D-SNP) with an $1,800 copayment per stay and no coinsurance for Medicare-covered acute and psychiatric care. While unlimited additional days are covered for acute stays, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice SNP-DE H5216-468 (PPO D-SNP) with no copay, though covered services generally require a 20% coinsurance and prior authorization. This includes outpatient hospital care, ambulatory surgical center services, substance abuse sessions, and outpatient blood services, which features no deductible for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice SNP-DE H5216-468 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice SNP-DE H5216-468 (PPO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) covers emergency services 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 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care services under the HumanaChoice SNP-DE H5216-468 (PPO D-SNP) are covered with no copay and a 20% coinsurance, including PCP visits, specialist care, therapy, telehealth, and up to 12 routine podiatry visits yearly. While some chiropractic services are covered, routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice SNP-DE H5216-468 (PPO D-SNP) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, glaucoma screenings, and memory fitness. Sub-services not covered under this plan include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home modifications, and counseling services.
Hearing Services See details
Hearing services are covered by HumanaChoice SNP-DE H5216-468 (PPO D-SNP) with no deductible, featuring one annual routine hearing exam with no copay and 20% coinsurance, and unlimited fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, excluding inner ear, outer ear, and over-the-ear models, while over-the-counter hearing aids are covered with no copay or coinsurance.
Vision Services See details
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) partially covers vision services, offering routine eye exams with no copay and a 20% coinsurance up to a $40 yearly limit, though other eye exams are not covered. Covered eyewear, including one pair of contact lenses or eyeglasses (lenses and frames) per year, features no copay and no coinsurance up to a $350 annual limit, while separate eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) partially covers dental services, offering a $4,000 annual maximum benefit with no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental services require a 20% coinsurance and no copay, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under HumanaChoice SNP-DE H5216-468 (PPO D-SNP) with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for insulin. Other covered Medicare Part B drugs require no copay, while chemotherapy and radiation drugs require a copay, with both carrying no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with a 20% coinsurance and no copay. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) covers diagnostic and radiological services with a 20% coinsurance and no copay, including lab services, outpatient diagnostic tests, therapeutic radiology, and X-rays. Prior authorization is required for all of these covered services.
Home Health Services See details
Home Health Services are covered by HumanaChoice SNP-DE H5216-468 (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HumanaChoice SNP-DE H5216-468 (PPO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice SNP-DE H5216-468 (PPO D-SNP) partially covers other services, offering acupuncture with no copay and 20% coinsurance, and over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while highly integrated services for dual eligibles are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved