HumanaChoice SNP-DE H5216-298 (PPO D-SNP)

H5216 - 298 - 0
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HumanaChoice SNP-DE H5216-298 (PPO D-SNP) is a Medicare Advantage Special Needs Plan by Humana.

This page features plan details for 2024 HumanaChoice SNP-DE H5216-298 (PPO D-SNP) H5216 – 298 – 0 available in Select Counties in Mississippi.

IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:

Locations

HumanaChoice SNP-DE H5216-298 (PPO D-SNP) is offered in the following locations.

Plan Overview

HumanaChoice SNP-DE H5216-298 (PPO D-SNP) offers the following coverage and cost-sharing.

Special Needs Plan Type:Dual-Eligible
Conditions Covered:
Insurer:Humana
Health Plan Deductible:$0.00
MOOP:$13,300 In and Out-of-network
$8,850 In-network
Drugs Covered:Yes
Please Note:
  • This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
  • Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.

Ready to sign up for HumanaChoice SNP-DE H5216-298 (PPO D-SNP) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

HumanaChoice SNP-DE H5216-298 (PPO D-SNP) has a monthly premium of $40.10. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $0.00 $40.10 $0.00 $214.80
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

HumanaChoice SNP-DE H5216-298 (PPO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$545.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Basic
Additional Gap Coverage:No
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$40.10$0.00

Initial Coverage Phase

After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

Drug TypeCost Share
Generic drugs25%
Brand-name drugs25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.

Additional Benefits

HumanaChoice SNP-DE H5216-298 (PPO D-SNP) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$13,300 In and Out-of-network
$8,850 In-network

Optional supplemental benefits

No

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network Yes, contact plan for further details

Outpatient hospital coverage

In-network $0 or $0-200 copay or 20% coinsurance per visit (Authorization is required.) (Referral is not required.)
out-of-network $55-200 copay or 20% coinsurance per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
out-of-network Primary$20 copay per visit (Not applicable.) (Not applicable.)
In-network Specialist$0 or $45 copay per visit (Authorization is not required.) (Referral is not required.)
out-of-network Specialist$55 copay per visit (Authorization is not required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network $0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$0 or $100 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$0 or $45 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$0 or $0-45 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures$20-55 copay or 20% coinsurance (Authorization is required.) (Referral is not required.)
In-network Lab services$0 or $0-45 copay (Authorization is required.) (Referral is not required.)
out-of-network Lab services$20-55 copay or 20% coinsurance (Authorization is required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$0 or $0-200 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)$55-200 copay or 20% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$0 or $0-125 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient x-rays$20-125 copay (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$0 or $45 copay (Authorization is required.) (Referral is not required.)
out-of-network Hearing exam$55 copay (Authorization is required.) (Referral is not required.)
In-network Fitting/evaluation$0 copay (There are no limits.) (Authorization is required.) (Referral is not required.)
out-of-network Fitting/evaluation50% coinsurance (There are no limits.) (Authorization is required.) (Referral is not required.)
In-network Hearing aids$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Hearing aids50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

In-network Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Routine eye exam$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Contact lenses$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

In-network Occupational therapy visit$0 or $20 copay (Authorization is required.) (Referral is not required.)
out-of-network Occupational therapy visit$55 copay (Authorization is required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$0 or $20 copay (Authorization is required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit$55 copay (Authorization is required.) (Referral is not required.)

Ground ambulance

In-network $0 or $200 copay (Not applicable.) (Not applicable.)
out-of-network $200 copay (Not applicable.) (Not applicable.)

Transportation

In-network $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Foot care (podiatry services)

In-network Foot exams and treatment$0 or $45 copay (Authorization is required.) (Referral is not required.)
out-of-network Foot exams and treatment$55 copay (Authorization is required.) (Referral is not required.)
In-network Routine foot care$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)0% or 20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)0% or 20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay or 20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Diabetes supplies$0 copay or 20% coinsurance per item (Authorization is required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0% or 0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Chemotherapy$0 copay or 20% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs$0 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Other Part B drugs$0 copay or 20% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs$0 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Part B Insulin drugs$0 copay or 20% coinsurance (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $0 or $625 per day for days 1 through 3
$0 per day for days 4 through 90
$0 per day for days 90 and beyond (Authorization is required.) (Referral is not required.)
out-of-network $625 per day for days 1 through 3
$0 per day for days 4 through 90 (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$0 or $625 per day for days 1 through 3
$0 per day for days 4 through 90 (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatric$625 per day for days 1 through 3
$0 per day for days 4 through 90 (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$0 or $30 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist$55 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$0 or $30 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist$55 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit$0 or $30 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit$55 copay (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit$0 or $30 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit$55 copay (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$0 or $203 per day for days 21 through 100 (Authorization is required.) (Referral is not required.)
out-of-network $0 per day for days 1 through 20
$203 per day for days 21 through 100 (Authorization is required.) (Referral is not required.)

Ready to sign up for HumanaChoice SNP-DE H5216-298 (PPO D-SNP) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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