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HumanaChoice SNP-DE H5216-268 (PPO D-SNP) H5216-268 • 2027 • Plymouth County, IA

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9850.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $500.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Plymouth County, IA
Local Enrollment
12 beneficiaries in Plymouth County
Last update:

Introduction

HumanaChoice SNP-DE H5216-268, offered by Humana, is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) identified by CMS Plan ID H5216-268. The plan's Preferred Provider Organization (PPO) provider network serves its covered medical benefits, and the plan includes Medicare Part D prescription drug coverage. Its 2027 costs include a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $500.00.

This plan is available to eligible beneficiaries who live in Plymouth County, Iowa. According to CMS, 12 beneficiaries in Plymouth County are enrolled in this plan. New members can contact the plan at (888)873-0686 (TTY 711) for help and additional plan information.

Eligibility

HumanaChoice SNP-DE H5216-268 is a Medicare D-SNP plan for people who qualify for both Medicare and Medicaid.

Special Needs Plan Type
Dual-Eligible Special Needs Plan (D-SNP)
Medicare Requirement
Medicare Part A and Part B
Special Needs Requirement
Must qualify for Medicaid
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Compare Similar Plans in Plymouth County

No other PPO D-SNP plans are available in Plymouth County, Iowa using the same plan-type comparison criteria.

Plan Benefits

HumanaChoice SNP-DE H5216-268 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5216-268.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5216-268-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Out-of-network: $0 copay
Specialist
In-network: $0 copay
Out-of-network: $0 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Out-of-network: $0 copay
Telehealth benefit
In-network: $0 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Out-of-network: 95% coinsurance
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0 copay
Out-of-network: $0 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic tests and procedures
In-network: $0 copay
Out-of-network: $0 copay

Emergency and Urgent Care Services

Emergency room care
$0 copay
Worldwide emergency care
Coming soon
Urgent care
$0 copay
Inpatient hospital care
In-network:
Tier 1
$0 per stay
Out-of-network:
$0 per stay
Skilled Nursing Facility
In-network:
Tier 1
$0 per day for days 1-20
$0 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$0 per day for days 21-100
$0 per stay
Ground ambulance
In-network: $0 copay
Out-of-network: $0 copay

Mental Health Services

Outpatient individual therapy
In-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy
In-network: $0 copay
Out-of-network: $0 copay
Inpatient psychiatric hospital care
In-network:
Tier 1
$0 per stay
Out-of-network:
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $0 copay
Out-of-network: $0 copay
Occupational therapy
In-network: $0 copay
Out-of-network: $0 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Out-of-network: $0 copay
Durable medical equipment
In-network: $0 copay
Out-of-network: $0 copay
Prosthetics
In-network: $0 copay
Out-of-network: $0 copay

Medicare Part B Drugs

Chemotherapy
In-network: $0 copay
Out-of-network: $0 copay
Other Part B drugs (Medicare-covered)
In-network: $0 copay
Out-of-network: $0 copay

Dental Services

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay

Vision Services

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames only
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
Not covered

Hearing Services

Hearing exam
In-network: $0 copay
Out-of-network: 95% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: 95% coinsurance
Prescription hearing aids
In-network: $0 copay
Out-of-network: 95% coinsurance
OTC hearing aids
In-network: $0 copay
Out-of-network: 95% coinsurance

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by HumanaChoice SNP-DE H5216-268 as a Part B benefit.

Prescription Drug Coverage

HumanaChoice SNP-DE H5216-268 includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

HumanaChoice SNP-DE H5216-268 (H5216-268-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($8.40)
Supplemental Part D Premium:$8.40
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$24.60
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $500.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Humana starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, HumanaChoice SNP-DE H5216-268 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

HumanaChoice SNP-DE H5216-268 (H5216-268-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$0.00 copay$0.00 copay
Preferred Brand25% coinsurance25% coinsurance
Non-Preferred Drug25% coinsurance25% coinsurance
Specialty Tier28% coinsurance25% coinsurance
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H5216)

CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.

2027 Medicare Star Ratings for Contract H5216
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Humana (official source) http://www.humana.com/medicare October 4, 2026
CMS.gov Dual Eligible Special Needs Plans (D-SNPs) April 28, 2026
Medicare.gov Compare types of Medicare Advantage Plans April 28, 2026
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You April 28, 2026

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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.