HumanaChoice SNP-DE H5216-331 (D-SNP) Costs & Coverage, Pawnee County, Oklahoma
HumanaChoice SNP-DE H5216-331 (D-SNP) Costs & Coverage, Pawnee County, Oklahoma
Discover how HumanaChoice SNP-DE H5216-331 (D-SNP PPO) stands out as a 2025 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by Humana are different than Original Medicare. This private health insurance option, available to qualified individuals in Pawnee County, OK, may include additional benefits that are not provided by Medicare Part A and Part B.
Plan ID H5216-331-0 Overview | |
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Health Plan ID: | H5216-331-0 |
Medicare Advantage Plan Type: | PPO |
Plan Year: | 2024 |
Monthly Premium: | $42.20 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Basic $545.00 deductible |
Supplemental Benefits: | Vision, Hearing |
Availability: | Pawnee County, OK |
Insured By: | Humana |
We're Here to Help You Enroll |
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Health Plan Cost Sharing & Benefits
HumanaChoice SNP-DE H5216-331 is a Preferred Provider Organization (PPO) plan. As a member of this D-SNP plan, you typically access care through in-network providers, but you have the flexibility to see out-of-network providers if needed. Keep in mind that visits to non-network providers may result in higher out-of-pocket costs.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | 0% Coinsurance |
Specialist: | 0% Coinsurance |
Wellness & Preventive Programs: | |
Preventive care: | 0% Coinsurance |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | 0% Coinsurance Prior Authorization Required |
Routine Foot Care: | 0% Coinsurance Prior Authorization Required |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | 0% Coinsurance Prior Authorization Required |
Routine chiropractic: | 0% Coinsurance Prior Authorization Required |
Emergency and Urgent Care | |
Emergency room care: | 0% Coinsurance |
Urgent care: | 0% Coinsurance |
Ground ambulance: | 0% Coinsurance |
Inpatient hospital care: | $2,050.00 per stay |
Outpatient hospital care: | 0% Coinsurance Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $196.00 per day for days 21 and beyond |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | 0% Coinsurance |
Outpatient group therapy: | 0% Coinsurance |
Inpatient psychiatric hospital care: | $1,872.00 per stay |
Outpatient group therapy: | 0% Coinsurance |
Outpatient individual therapy: | 0% Coinsurance Prior Authorization Required |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | 0% Coinsurance Prior Authorization Required |
Occupational therapy: | 0% Coinsurance Prior Authorization Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 0% Coinsurance Prior Authorization Required |
Durable medical equipment: | 0% Coinsurance Prior Authorization Required |
Prosthetics: | 0% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | 0% Coinsurance Prior Authorization Required |
Lab services: | 0% Coinsurance Prior Authorization Required |
Outpatient x-rays: | 0% Coinsurance Prior Authorization Required |
Diagnostic tests and procedures: | 0% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 0% Coinsurance |
Other Part B drugs (Medicare-covered) | 0% Coinsurance |
Supplemental Health Plan Benefits (H5216-331-0)
The following is a summary of the supplemental benefits Humana includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing | |
Fitting/evaluation (In-Network) | $0 Copay Prior Authorization Required, Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Prior Authorization Required |
Vision | Maximum vision benefit: | $500.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay Prior Authorization Required |
Contact lenses (In-Network) | $0 Copay |
Additional Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
HumanaChoice SNP-DE H5216-331 includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $42.20 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $42.20 |
Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. This is the amount you must pay at the pharmacy before Humana begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, HumanaChoice SNP-DE H5216-331 has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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$0 copay on all covered generic and brand-name prescriptions. |
5-Star Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage D-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Humana plan.
CMS Measure | Star Rating |
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2025 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 |
How to Qualify for Enrollment in HumanaChoice SNP-DE H5216-331
To enroll in HumanaChoice SNP-DE H5216-331 you must qualify for both Medicare and Medicaid and live in one of the plan's service areas. Eligibility for Medicare requires you to be either 65 years of age or older, or have received Social Security Disability Insurance for at least 24 months. For Medicaid eligibility, your income and assets must fall at or below your state's thresholds.
Before enrolling in HumanaChoice SNP-DE H5216-331, or any other dual-eligible SNP, make sure to ask yourself the following questions:
- What out-of-pocket costs should I anticipate (premiums, deductibles, copayments)?
- Will I be able to continue seeing my doctors? Are they within the plan's network?
- Are the plan's in-network providers and facilities conveniently located?
- Does the plan cover services from providers who are out-of-network?
- Will I need a referral to visit a specialist?
- Are my medications included in the Part D plan's formulary? What options are available if I can't afford my medications?
- What special accommodations does the plan provide for individuals with disabilities?
- Does the plan include free meal delivery after a hospital stay?
- What support is available for caregivers? Is adult day care covered?
- Does the plan provide a prepaid card for over-the-counter medications and covered groceries?
Medicare Special Needs Plan Enrollment Periods
After determining your eligibility for HumanaChoice SNP-DE H5216-331, it’s important to be aware of the Medicare Enrollment Periods, which determine when you can enroll in or change your plan. Depending on your circumstances, one of the following periods will apply:
- Initial Enrollment Period (IEP): The first time you can enroll in Medicare, typically around your 65th birthday.
- Annual Enrollment Period (AEP): Occurs yearly and allows you to make changes to your Medicare coverage.
- Special Enrollment Periods (SEPs): Special circumstances, such as moving or losing other coverage, may qualify you to enroll outside of the usual periods.
For more details on enrollment periods, you can learn more here and make sure you’re well-informed about your Medicare choices.
Contact Humana
Call 1-877-388-0596 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Sun 8am-11pm EST) and learn more about this Special Needs Plan and other plans on this site.
You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
Plan Website: | http://www.humana.com/medicare |
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Formulay Information: | https://www.humana.com/pharmacy/ |
Pharmacy Information: | Humana Pharmacy Page |
Prospective Members: | (800)833-2364 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered are by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.