HumanaChoice SNP-DE H5216-420 (PPO D-SNP) Medicare Special Need Plan H5216-420 • 2027
- 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, $600.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 9,062 beneficiaries
Introduction
CMS Plan ID H5216-420 identifies HumanaChoice SNP-DE H5216-420, a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered by Humana. Its provider network is a Preferred Provider Organization (PPO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has 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 $600.00.
Enrollment across the plan's service areas totals 9,062 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
Eligibility
HumanaChoice SNP-DE H5216-420 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.
Plan Benefits
HumanaChoice SNP-DE H5216-420 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 H5216-420.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $0 copay |
In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
| Specialist | In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay |
| Telehealth benefit | In-network: $0 or $0-$35 copay, 0% or 20% coinsurance | In-network: $0 copay, 0% or 20% coinsurance |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | Not covered |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: 95% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0 or $0-$345 copay, 0% or 20% coinsurance Out-of-network: $0 or $0-$345 copay, 0% or 20% coinsurance |
In-network: $0 or $0-$335 copay, 0% or 20% coinsurance Out-of-network: $0 or $0-$335 copay, 0% or 20% coinsurance |
| Lab services | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 or $0-$30 copay, 0% or 20% coinsurance Out-of-network: $0 or $0-$30 copay, 0% or 20% coinsurance |
| Outpatient x-rays | In-network: $0 copay, 0% or 20% coinsurance Out-of-network: $0 copay, 0% or 20% coinsurance |
In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
| Diagnostic tests and procedures | In-network: $0 copay, 0% or 20% coinsurance Out-of-network: $0 copay, 0% or 20% coinsurance |
In-network: $0 copay, 0% or 20% coinsurance Out-of-network: $0 copay, 0% or 20% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $0 or $115 copay | $0 or $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | 0% or 20% coinsurance | 0% or 20% coinsurance |
| Inpatient hospital care | In-network: Tier 1 $0 or $1,560 per stay Out-of-network: $0 or $1,560 per stay |
In-network: Tier 1 $0 or $2,230 per stay Out-of-network: $0 or $2,230 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $0 or $221 per day for days 21-100 Out-of-network: $0 per day for days 1-20 $0 or $221 per day for days 21-100 $0 per stay |
In-network: Tier 1 $0 per day for days 1-20 $0 or $218 per day for days 21-100 Out-of-network: $0 per day for days 1-20 $0 or $218 per day for days 21-100 $0 per stay |
| Ground ambulance | In-network: $0 or $325 copay Out-of-network: $0 or $325 copay |
In-network: $0 or $335 copay Out-of-network: $0 or $335 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 or $35 copay Out-of-network: $0 or $35 copay |
In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
| Outpatient group therapy | In-network: $0 or $35 copay Out-of-network: $0 or $35 copay |
In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $0 or $1,560 per stay Out-of-network: $0 or $1,560 per stay |
In-network: Tier 1 $0 or $2,230 per stay Out-of-network: $0 or $2,230 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
| Occupational therapy | In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay, 0% or 20% coinsurance Out-of-network: $0 copay, 0% or 20% coinsurance |
In-network: $0 copay, 0% or 20% coinsurance Out-of-network: $0 copay, 0% or 20% coinsurance |
| Durable medical equipment | In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
In-network: $0 copay, 0% or 20% coinsurance Out-of-network: $0 copay, 0% or 20% coinsurance |
| Prosthetics | In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
In-network: 0% or 20% coinsurance Out-of-network: 0% or 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0% or 0%-20% coinsurance Out-of-network: 0% or 20% coinsurance |
In-network: 0% or 0%-20% coinsurance Out-of-network: 0% or 20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: $0 copay, 0% or 0%-20% coinsurance Out-of-network: $0 copay, 0% or 20% coinsurance |
In-network: $0 copay, 0% or 0%-20% coinsurance Out-of-network: $0 copay, 0% or 20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Dental x-rays | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Periodontics | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Endodontics | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Restorative services | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: 95% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 95% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
| Prescription hearing aids | In-network: $0 copay Out-of-network: 95% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
| OTC hearing aids | In-network: $0 copay Out-of-network: 95% coinsurance |
In-network: $0 copay Out-of-network: $0 copay |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by HumanaChoice SNP-DE H5216-420 as a Part B benefit.
Prescription Drug Coverage
HumanaChoice SNP-DE H5216-420 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($3.50) |
| Supplemental Part D Premium: | $3.50 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.27 |
| 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 $600.00 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 H5216-420 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | $0.00 copay | $0.00 copay |
| Preferred Brand | 25% coinsurance | 25% coinsurance |
| Non-Preferred Drug | 25% coinsurance | 25% coinsurance |
| Specialty Tier | 26% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5216)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| 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 |
Contact Information for Humana
- Website
- Humana Plan Page
- Providers
- Humana Providers Page
- Formulary
- Humana Formulary Page
- Pharmacy
- Humana Pharmacy Page
- New Member Health Plan Help
- (888)873-0686
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (888)873-0686
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
HumanaChoice SNP-DE H5216-420 (H5216-420-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| 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.
| 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 | Understanding 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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