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Humana Dual Select H5216-385 (PPO D-SNP)

Health Insurance Company: Humana

Medicare Advantage Plan Details

Medicare-Medicaid Dual Eligible (D-SNP)

Humana
$27 /mo
monthly premium
Humana Dual Select H5216-385 (PPO D-SNP)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Dental
  • Vision
  • Hearing
3.5
out of 5 stars

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$9350
Rx Drug Coverage
Yes
Rx Deductible
$590
Primary Doctor Office Visit
$0 or $5 copay per visit
Specialist Office Visit
$0 or $45 copay per visit

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
Yes
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: $0 or $5 copay per visit
Out-of-network: $5 copay per visit
Specialist Office Visit
In-network: $0 or $45 copay per visit
Out-of-network: $45 copay per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0 copay or 25% coinsurance

Emergency Room

$0 or $110 copay per visit (always covered)

Ambulance Coverage

In-network: $0 or $315 copay
Out-of-network: $315 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0 or $0-45 copay or 20% coinsurance
Out-of-network: $10-45 copay or 20% coinsurance
Medicare-covered lab services: In-network: $0 copay or 20% coinsurance
Out-of-network: $0 copay or 20% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0 or $200-325 copay or 19-20% coinsurance
Out-of-network: $200-325 copay or 19-20% coinsurance
Medicare-covered x-ray services: In-network: $0 or $5 copay or 20% coinsurance
Out-of-network: $5 copay or 20% coinsurance

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: 0% or 20% coinsurance per visit
Out-of-network: 20% coinsurance per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $0 or $595 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Out-of-network: $595 per day for days 1 through 4
$0 per day for days 5 through 90
Inpatient hospital psychiatric:
In-network: $0 or $595 per day for days 1 through 3
$0 per day for days 4 through 90
Out-of-network: $595 per day for days 1 through 3
$0 per day for days 4 through 90

Rehabilitation Coverage

Occupational therapy services:
In-network: $0 or $35 copay
Out-of-network: $35 copay
Physical therapy and speech and language therapy services:
In-network: $0 or $35 copay
Out-of-network: $35 copay

Urgent Care Coverage

$0 or $45 copay per visit (always covered)

Skilled Nursing Facility (SNF)

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

Mental Health Coverage

Medicare-covered individual sessions: In-network: $0 or $45 copay
Out-of-network: $45 copay
Medicare-covered group sessions: In-network: $0 or $45 copay
Out-of-network: $45 copay

Dental, Vision, Hearing Benefits

Dental Services

Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay

Vision Benefits

Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: $0 copay
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses: In-network: $0 copay
Out-of-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $0 or $45 copay
Out-of-network: $45 copay
Hearing aids:
Hearing aids (all types): In-network: $0 copay
Out-of-network: $0 copay

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
No
Acupuncture
Yes
Massage Therapy
No
Health Education
No
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
No
In-home support services
No
Home and bathroom safety devices
No
Meals for short duration
Yes

Plan Links

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Where This Plan is Available

Additional Plan Info

Plan Year:
2025
Insurance Company Website:
Humana

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield
  • Aspire Health Plan
  • Baylor Scott & White Health Plan
  • Capital Blue Cross
  • Cigna Healthcare
  • Dean Health Plan
  • Devoted Health
  • Florida Blue Medicare
  • Freedom Health
  • GlobalHealth
  • Health Care Service Corporation
  • Healthy Blue
  • HealthSun
  • Humana
  • Molina Healthcare
  • Mutual of Omaha
  • Medica Central Health Plan
  • Optimum HealthCare
  • Premera Blue Cross
  • SCAN Health Plan
  • Simply
  • UnitedHealthcareⓇ
  • Wellcare
  • WellPoint