Wisconsin Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)
Monthly Premium
Your Cost
$44
by Humana
Additional Coverage
HearingVisionDental
Overall Government Star Rating
3.5
out of 5 stars
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Plan Overview
Plan Name
HumanaChoice SNP-DE H5216-420 (PPO D-SNP)
Insurance Carrier
Humana
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
PPO
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Wisconsin 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.
Cost Summary
Monthly Premium
$44
Annual Deductible
Coming soon
Max Out-of-Pocket
$9,350
Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit
ER visit
$0 or $110 copay per visit (always covered)
Ambulance
$0 or $315 copay
HumanaChoice SNP-DE H5216-420 (PPO D-SNP) has a monthly premium cost of $44 per month, with an annual deductible of Coming soon 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 H5216-420 (PPO D-SNP) are defined below.
Additional Benefits and Coverage
Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing
HumanaChoice SNP-DE H5216-420 (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 H5216-420 (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. HumanaChoice SNP-DE H5216-420 (PPO D-SNP) includes coverage for the following additional benefits:
Other benefits
Fitness benefit
Not covered
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
Comparing the Quality Score of HumanaChoice SNP-DE (PPO D-SNP) to Other Plans in Wisconsin
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, HumanaChoice SNP-DE (PPO D-SNP) received an overall government quality rating of 3.5 stars out of 5 stars.
HumanaChoice SNP-DE (PPO D-SNP) performed worse than Wisconsin’s State average overall quality score of 3.8 stars.
This Plan’s 5-star Gov’t Quality Score
Wisconsin State Average Score
Overall Government 5 Star Quality Rating
3.5
3.8
Summary rating of health plan quality
3.5
3.6
Staying healthy: screenings, tests, & vaccines
4
3.5
Managing chronic (long term) conditions
4
3.3
Member experience with health plan
4
3.8
Member complaints & changes in the health plan's performance
4
3.9
Health plan customer service
4
4.1
Summary rating of drug plan quality
3.5
3.5
Drug plan customer service
4
4.0
Member complaints & changes in the drug plan's performance
3
3.8
Member experience with the drug plan
4
3.3
Drug safety & accuracy of drug pricing
3
3.3
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
HumanaChoice SNP-DE (PPO D-SNP) received 3.5 stars for its health plan quality score which is worse than the Wisconsin State average health plan quality score of 3.6 stars.
HumanaChoice SNP-DE (PPO D-SNP) received 3.5 stars for its drug plan quality score which is the same as the Wisconsin State average drug plan quality score of 3.5 stars.
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Specialist visit
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Lab services
In-network: $0 or $0-30 copay or 20% coinsurance
Out-of-network: $0-30 copay or 20% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0 or $240-350 copay or 20% coinsurance
Out-of-network: $240-350 copay or 20% coinsurance
Outpatient x-rays
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Emergency care
$0 or $110 copay per visit (always covered)
Urgent care
0% or 20% coinsurance per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $0 or $2,185 per stay
Out-of-network: 50% per stay
Outpatient hospital coverage
In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$0 or $214 per day for days 21 through 100
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 or $315 copay
Out-of-network: $315 copay
Therapy services
Occupational therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: 0% or 20% coinsurance
Out-of-network: 20% coinsurance
Opioid treatment services
Opioid treatment services
Covered
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay or 18% coinsurance per item
Out-of-network: $0 copay or 18% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 0% or 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay or 20% coinsurance per item
Out-of-network: $0 copay or 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers
Initial coverage phase
Catastrophic 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% or 0-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: $0 copay or 0-20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Extra Benefits
Hearing
Hearing exam
In-network: 0% or 20% coinsurance
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
When Can I Sign Up for Medicare?
Enter your birthday month and year to learn when you can sign up for different Medicare plan options.
In this article we rank Wisconsin Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
The Medicare landscape in Wisconsin is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in Wisconsin.
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