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HumanaChoice SNP-DE H5216-469 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5216-469 (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 H5216-469 (PPO D-SNP) in 2026, please refer to our full plan details page.
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice SNP-DE H5216-469 (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 H5216-469 (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 H5216-469 (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 H5216-469 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.20. 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 H5216-469 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5216-469 (PPO D-SNP) prescription drug plan has an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled at a standard pharmacy or through preferred mail order. If you choose standard mail order for these generics, you will pay a copay ranging from $10 to $30 for Tier 1 and $20 to $60 for Tier 2. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan requires a 25% coinsurance. This 25% coinsurance rate is the same whether you use a standard pharmacy, preferred mail order, or standard mail order. Knowing these details helps you plan for your medication costs under this Humana choice plan.
Additional Benefits
The HumanaChoice SNP-DE H5216-469 (PPO D-SNP) offers comprehensive medical coverage, balancing fixed copays with coinsurance for key services. Inpatient hospital stays require a copay of $2,230 for acute care and $2,080 for psychiatric care, both with no coinsurance. For outpatient services, primary care, and specialist visits, members will pay no copay and a 20% coinsurance. Supplemental benefits like home health care, preventive services, and most dental care up to a $2,500 annual limit are covered with no copay and no coinsurance. Routine hearing and vision exams also feature no copay and a 20% coinsurance, alongside a $450 annual eyewear allowance with no copay or coinsurance. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) covers inpatient acute stays with a $2,230 copay per stay and inpatient psychiatric stays with a $2,080 copay per stay, both with no coinsurance. Prior authorization is required, and the benefit is only partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for these services, and there is no deductible for outpatient blood services, with the cost of the first three pints being waived.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice SNP-DE H5216-469 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 36 yearly one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HumanaChoice SNP-DE H5216-469 (PPO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a 20% coinsurance (up to $40 per visit) 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 and specialist services under HumanaChoice SNP-DE H5216-469 (PPO D-SNP) are covered with no copay and a 20% coinsurance, which also applies to mental health, therapy, and telehealth services. Podiatry services are not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) provides partially covered preventive services with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs. However, the plan does not cover additional services such as fitness benefits, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home modifications, and counseling.
Hearing Services See details
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) covers hearing exams and hearing aids with no deductible, featuring no copay and 20% coinsurance for routine exams, and no copay or coinsurance for fitting evaluations. OTC hearing aids are covered with no copay or coinsurance, while prescription hearing aids are partially covered with no copay or coinsurance, excluding inner ear, outer ear, and over-the-ear models.
Vision Services See details
Vision services are partially covered under the HumanaChoice SNP-DE H5216-469 (PPO D-SNP) plan with no deductibles, offering routine eye exams with no copay and 20% coinsurance, and eyewear with no copay and no coinsurance up to a $450 annual limit. While routine exams, contact lenses, and eyeglasses (lenses and frames) are covered, other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) partially covers dental services up to a $2,500 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive dental care, while Medicare-covered dental services have no copay and a 20% coinsurance. Specific services not covered under this plan include fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) covers home infusion bundled services with prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while other Part B drugs, including chemotherapy and radiation, feature 0% to 20% coinsurance and no copay for non-chemotherapy drugs.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice SNP-DE H5216-469 (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice SNP-DE H5216-469 (PPO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for most of these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice SNP-DE H5216-469 (PPO D-SNP) covers diagnostic and radiological services, subject to prior authorization and a 20% coinsurance. Members will pay no copay for diagnostic tests, lab services, and therapeutic radiology, while outpatient X-rays require a $50 copay and diagnostic radiology services require a copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice SNP-DE H5216-469 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no copay under the HumanaChoice SNP-DE H5216-469 (PPO D-SNP) plan, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered by the plan and instead require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by HumanaChoice SNP-DE H5216-469 (PPO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HumanaChoice SNP-DE H5216-469 (PPO D-SNP), including acupuncture with no copay and 20% coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while highly integrated services and other additional services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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