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Humana Dual Integrated (PPO D-SNP) Medicare Special Need Plan H5216-480 • 2027

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, $150.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
0 beneficiaries
Last update:

Introduction

CMS Plan ID H5216-480 identifies Humana Dual Integrated, 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 $150.00.

Enrollment across the plan's service areas totals 0 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.

Eligibility

Humana Dual Integrated 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

Humana Dual Integrated 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 H5216-480.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Specialist In-network: $0 copay
Out-of-network: $0 copay		 Coming soon

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Telehealth benefit In-network: $0 copay Coming soon
Routine chiropractic Not covered Coming soon
Fitness benefits Coming soon Coming soon
Health education Not covered Coming soon
Counseling services Not covered Coming soon
Over-the-counter drug benefits In-network: $0 copay
Out-of-network: 95% coinsurance		 Coming soon
Health transportation (non-emergency) Coming soon Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Lab services In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Outpatient x-rays In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Diagnostic tests and procedures In-network: $0 copay
Out-of-network: $0 copay		 Coming soon

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $0 copay Coming soon
Worldwide emergency care Coming soon Coming soon
Urgent care $0 copay Coming soon
Inpatient hospital care In-network:
Tier 1
$0 per stay
Out-of-network:
$0 per stay		 Coming soon
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		 Coming soon
Ground ambulance In-network: $0 copay
Out-of-network: $0 copay		 Coming soon

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Outpatient group therapy In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Inpatient psychiatric hospital care In-network:
Tier 1
$0 per stay
Out-of-network:
$0 per stay		 Coming soon

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Occupational therapy In-network: $0 copay
Out-of-network: $0 copay		 Coming soon

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Durable medical equipment In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Prosthetics In-network: $0 copay
Out-of-network: $0 copay		 Coming soon

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Other Part B drugs (Medicare-covered) In-network: $0 copay
Out-of-network: $0 copay		 Coming soon

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Dental x-rays In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Cleaning In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Periodontics In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Endodontics In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Restorative services In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Implant services Not covered Coming soon
Orthodontics Not covered Coming soon
Oral/Maxillofacial surgery In-network: $0 copay
Out-of-network: $0 copay		 Coming soon

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Contact lenses In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Eyeglass frames only Not covered Coming soon
Eyeglass lenses only Not covered Coming soon
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay		 Coming soon
Upgrades Not covered Coming soon

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay
Out-of-network: 95% coinsurance		 Coming soon
Fitting/evaluation In-network: $0 copay
Out-of-network: 95% coinsurance		 Coming soon
Prescription hearing aids In-network: $0 copay
Out-of-network: 95% coinsurance		 Coming soon
OTC hearing aids In-network: $0 copay
Out-of-network: 95% coinsurance		 Coming soon

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Coming soon
Home-based palliative care Not covered Coming soon
Personal emergency response system Coming soon Coming soon
Weight management programs Not covered Coming soon
Wigs for chemotherapy-related hair loss Coming soon Coming soon
Alternative therapies Not covered Coming soon
Massage therapy Not covered Coming soon
Home/bathroom safety devices Not covered Coming soon

Certain preventive services are covered 100% by Humana Dual Integrated as a Part B benefit.

Prescription Drug Coverage

Humana Dual Integrated 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.

Humana Dual Integrated (H5216-480-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($26.40)
Supplemental Part D Premium:$26.40
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$7.28
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 $150.00 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, Humana Dual Integrated may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Humana Dual Integrated (H5216-480-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayNot available
Generic$0.00 copayNot available
Preferred Brand25% coinsuranceNot available
Non-Preferred Drug25% coinsuranceNot available
Specialty Tier31% coinsuranceNot available
*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.

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 CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services CY2027 Landscape (202609.1)
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2027 Star Ratings Data Tables
Plan Benefits Package Centers for Medicare & Medicaid Services PBP Benefits-2027
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-09

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 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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