D-SNP Plan Costs & Benefits

HumanaChoice SNP-DE H5216-302 is a Preferred Provider Organization (PPO) plan. PPO plan members usually use in-network healthcare providers but can go out of network when necessary. However, visits to non-network providers could cost significantly more.

Costs vary widely from plan to plan. It is beneficial to compare costs, including premiums, deductibles, and copays, and apply them to your personal situation.

Healthcare Service	Member Cost
Health plan deductible	$0
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$12,450 In and Out-of-network $8,300 In-network
Doctor Visits
Primary (In-Network)	$0 copay
Primary (Out-of-Net)	20% coinsurance per visit
Specialist (Out-of-Net)	20% coinsurance per visit
Wellness programs (e.g., fitness, nursing hotline)	Covered
Preventive care	$0 copay
Mental Health Services
Outpatient individual therapy visit with a psychiatrist (Out-of-Net)	20% coinsurance (authorization required)
Outpatient individual therapy visit (In-Network)	$0 copay (authorization required)
Inpatient hospital - psychiatric (Out-of-Net)	$1,871 per stay (authorization required)
Outpatient group therapy visit (In-Network)	$0 copay (authorization required)
Outpatient group therapy visit with a psychiatrist (In-Network)	$0 copay (authorization required)
Outpatient individual therapy visit (Out-of-Net)	20% coinsurance (authorization required)
Outpatient group therapy visit (Out-of-Net)	20% coinsurance (authorization required)
Outpatient group therapy visit with a psychiatrist (Out-of-Net)	20% coinsurance (authorization required)
Inpatient hospital - psychiatric (In-Network)	$0 copay (authorization required)
Rehabilitation Services
Physical therapy and speech and language therapy visit (Out-of-Net)	20% coinsurance (authorization required)
Physical therapy and speech and language therapy visit (In-Network)	$0 copay (authorization required)
Occupational therapy visit (In-Network)	$0 copay (authorization required)
Medical Equipment / Supplies
Diabetes supplies (Out-of-Net)	$0 copay or 20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs) (In-Network)	$0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen) (Out-of-Net)	20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen) (In-Network)	$0 copay (authorization required)
Diabetes supplies (In-Network)	$0 copay (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Diagnostic tests and procedures (Out-of-Net)	$0 copay or 20% coinsurance (authorization required)
Lab services (In-Network)	$0 copay (authorization required)
Outpatient x-rays (In-Network)	$0 copay (authorization required)
Outpatient x-rays (Out-of-Net)	20% coinsurance (authorization required)
Lab services (Out-of-Net)	$0 copay (authorization required)
Diagnostic radiology services (e.g., MRI) (Out-of-Net)	$0 copay or 20% coinsurance (authorization required)
Diagnostic tests and procedures (In-Network)	$0 copay (authorization required)
Medicare Part B Drugs
Chemotherapy (In-Network)	$0 copay (authorization required)
Other Part B drugs (In-Network)	$0 copay (authorization required)
Other Part B drugs (Out-of-Net)	$0 copay or 20% coinsurance (authorization required)
Foot Care (podiatry Services)
Foot exams and treatment (Out-of-Net)	20% coinsurance (authorization required)
Routine foot care	Not covered
Hearing
Hearing aids (Out-of-Net)	$0 copay (limits may apply)
Fitting/evaluation (Out-of-Net)	$0 copay (authorization required)
Hearing exam (Out-of-Net)	20% coinsurance (authorization required)
Hearing exam (In-Network)	$0 copay (authorization required)
Fitting/evaluation (In-Network)	$0 copay (authorization required)
Preventive Dental
Dental x-ray(s) (Out-of-Net)	$0 copay (limits may apply)
Fluoride treatment (Out-of-Net)	$0 copay (limits may apply)
Cleaning (In-Network)	$0 copay (limits may apply)
Fluoride treatment (In-Network)	$0 copay (limits may apply)
Cleaning (Out-of-Net)	$0 copay (limits may apply)
Oral exam (In-Network)	$0 copay (limits may apply)
Oral exam (Out-of-Net)	$0 copay (limits may apply)
Comprehensive Dental
Endodontics (Out-of-Net)	$0 copay (authorization required, limits may apply)
Extractions (In-Network)	$0 copay (authorization required, limits may apply)
Non-routine services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Restorative services (In-Network)	$0 copay (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Non-routine services (In-Network)	$0 copay (authorization required, limits may apply)
Extractions (Out-of-Net)	$0 copay (authorization required, limits may apply)
Diagnostic services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Periodontics (In-Network)	$0 copay (authorization required, limits may apply)
Periodontics (Out-of-Net)	$0 copay (authorization required, limits may apply)
Endodontics (In-Network)	$0 copay (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network)	$0 copay (authorization required, limits may apply)
Restorative services (Out-of-Net)	$0 copay (authorization required, limits may apply)
Vision
Eyeglasses (frames and lenses) (Out-of-Net)	$0 copay (authorization required, limits may apply)
Contact lenses (In-Network)	$0 copay (authorization required, limits may apply)
Upgrades	Not covered
Contact lenses (Out-of-Net)	$0 copay (authorization required, limits may apply)
Eyeglass lenses	Not covered
Routine eye exam (Out-of-Net)	$0 copay (authorization required, limits may apply)
Other	Not covered
Eyeglass frames	Not covered
Eyeglasses (frames and lenses) (In-Network)	$0 copay (authorization required, limits may apply)
Emergency Care / Urgent Care
Emergency	$0 copay
Ground ambulance	20% coinsurance
Inpatient hospital coverage	$0 copay
Outpatient hospital coverage	20% coinsurance per visit
Skilled Nursing Facility	$0 per day for days 1 through 20 $188 per day for days 21 through 100
Optional supplemental benefits	No

Prescription Costs & Benefits

A basic benefit Part D plan is bundled with this health plan. This simply means that HumanaChoice SNP-DE H5216-302 covers the minimum amount required by Medicare, whereas enhanced benefit plans cover more of the overall costs and may include more benefits.

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.

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $505.00. 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 H5216-302 has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.

CMS 5-Star Rating

Each year Medicare rates D-SNP plans, like HumanaChoice SNP-DE H5216-302, in nine categories. Medicare's plan ratings help consumers understand the quality of care and service they can expect if they qualify and choose to enroll.

Do You Qualify to Join HumanaChoice SNP-DE H5216-302?

Unfortunately, not everyone on Medicare will qualify to join HumanaChoice SNP-DE H5216-302. To join a 2023 Medicare Special Needs Plan in Washoe County, Nevada you must be eligible for both Medicare and Medicaid. To qualify for Medicare, you must be age 65 or older. People with SSDI benefits for a disability qualify after 24 months.

Nevada Medicaid eligibility is based on your income and assets. Here are Nevada's Medicaid thresholds.

If you don't qualify for HumanaChoice SNP-DE H5216-302, or another Medicare Special Needs Plan in your area, Medicare Advantage plans available in Washoe County, Nevada may be another option.

Contact Humana

The Medicare SNP Plans for Washoe County, Nevada information on this page originates from Medicare.gov and was last updated by All Medicare on February 2, 2023.