HumanaChoice SNP-DE H5216-331 (PPO D-SNP)

Oklahoma Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)


Monthly Premium

Your Cost
$0
by Humana

Additional Coverage

HearingVisionDental

Overall Government Star Rating

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Plan Name
HumanaChoice SNP-DE H5216-331 (PPO D-SNP)
Insurance Carrier
Humana
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
PPO

HumanaChoice SNP-DE H5216-331 (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Oklahoma and offered by the health insurance company Humana. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$9,350
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

HumanaChoice SNP-DE H5216-331 (PPO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $14,000 In and Out-of-network $9,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for HumanaChoice SNP-DE H5216-331 (PPO D-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

HumanaChoice SNP-DE H5216-331 (PPO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. HumanaChoice SNP-DE H5216-331 (PPO D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. HumanaChoice SNP-DE H5216-331 (PPO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$14,000 In and Out-of-network
$9,350 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: 20% coinsurance per visit
Specialist visit
In-network: $0 copay
Out-of-network: 20% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: 20% coinsurance
Outpatient x-rays
In-network: $0 copay
Out-of-network: $50 copay or 20% coinsurance
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
In-network: $0 copay
Out-of-network: $2,185 per stay
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: 19-20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 copay
Out-of-network: $0 per day for days 1 through 20
$214 per day for days 21 through 100

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $0 copay
Out-of-network: 20% coinsurance

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 19% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 19% coinsurance
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: 19% coinsurance
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: 19% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Out-of-network: $0 copay or 18% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25% coinsurance

Brand-name drugs :
25% coinsurance


Generic drugs :
0% coinsurance

Brand-name drugs :
0% coinsurance

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
In-network: $0 copay
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: $0 copay
Out-of-network: $0 copay or 20% coinsurance

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: 20% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
Not covered
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

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

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