Medicare Advantage · D-SNP · Local PPO · 2027
HumanaChoice SNP-DE H5216-164 (PPO D-SNP)
No referral needed to see a specialist
At a glance: $0 monthly premium and $0 primary care visits.
Eligibility required for this D-SNP. You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. See who can enroll
- Monthly premium
- $0
- Part B premium separate
- Yearly limit
- $9,850
- Most you’d pay for in-network care
- Dental
- $3,000/yr
- Preventive & comprehensive dental allowance
- Doctor visits
- $0
- Primary care · specialists 20%
Check this plan for you
Add your doctors and prescriptions to see how they work with this plan.
- DentalPreventive & comprehensive dental allowance
- $3,000/yr
- OTC allowance
- $110/month
- VisionEyewear allowance
- $250/yr
- Hearing$0 copay per hearing aid
- Included
- Fitness$0 fitness benefit
- Included
- Transportation100 one-way trips/year
- Included
- MealsMeal benefit
- Included
This is a supplemental benefit with plan-specific limits. See plan documents for details.
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Enrollment options depend on where you live. Enter your ZIP code so we can show the right ways to enroll in this plan.
Who can enroll
Eligibility for this Special Needs Plan
Eligibility required for this D-SNP
You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.
- Integration status
- CO
Common dual-eligibility labels
These definitions are educational. They do not confirm which Medicaid categories this specific plan accepts.
- FBDE
- Full Medicaid benefits in addition to Medicare.
- QMB+
- QMB help with Medicare costs plus full Medicaid benefits.
- SLMB+
- SLMB help with the Part B premium plus full Medicaid benefits.
- QMB
- Help with Medicare premiums and Medicare-covered cost sharing.
Check the Summary of Benefits or Evidence of Coverage for the exact Medicaid levels this plan accepts.
Could a Medicare Savings Program help?
Medicare Savings Programs are run by each state. The 2026 federal baseline monthly income limits are:
- QMB: $1,350 for one person or $1,824 for a married couple
- SLMB: $1,616 for one person or $2,184 for a married couple
- QI: $1,816 for one person or $2,455 for a married couple
Alaska, Hawaii, and some states use different limits or resource rules. Qualifying for an MSP does not by itself confirm eligibility for this D-SNP. Apply through your state Medicaid office.
Learn about QMB, SLMB, and QIExtra benefits for members who qualify
- Food and produce benefit
- Non-medical transportation benefit
- General supports for living
- Pest control service
- Indoor air quality equipment and services
- Social needs benefit
These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.
Costs and copays
Deductible, yearly limit, visits, hospital stays and drug tiers
- Drug deductiblePer year
- $200
- Yearly limitIn-network care, not counting drugs
- $9,850
- Yearly limit, in and out of networkCombined, not counting drugs
- $14,800
- Primary doctorPer visit
- $0
- SpecialistPer visit · no referral needed
- 20%
- Hospital stayNo limit on covered hospital days
- $1,955 per stay
- Inpatient mental healthHospital stay
- $1,805 per stay
- Outpatient surgeryPer procedure
- $0–$35
- Emergency roomPer visit
- $115
- Urgent carePer visit
- 20% (max $40/visit)
- Tier 1 · Preferred Generic30-day supply at a retail pharmacy
- $0
- Tier 2 · Generic30-day supply at a retail pharmacy
- $0
- Tier 3 · Preferred Brand30-day supply at a retail pharmacy, after deductible
- 25%
- Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy, after deductible
- 25%
- Tier 5 · Specialty30-day supply at a retail pharmacy, after deductible
- 31%
This plan is for people with Medicaid. What you pay depends on your Medicaid level: with QMB, your share of Medicare-covered services is covered; with full Medicaid benefits, your state may also cover Medicaid-covered services. Your state Medicaid office can confirm your level — or call us at 1-866-764-3312 (TTY 711) and a Licensed Medicare Advisor will help confirm it and discuss this plan's details with you. If you lose Medicaid eligibility, you may be billed the plan's cost sharing.
Our take
Where this plan shines, and what to know
Where this plan shines
- This plan has a $0 monthly premium.
- See your primary doctor for $0.
- Highly rated by CMS (4 stars).
Things to know before you enroll
- This plan’s out-of-pocket maximum is above the national median.
- Limited coverage while traveling outside the plan’s service area.
Similar plans
Other Medicare Advantage plans offered in Missouri
Browse the full 2027 Dual Eligible Special Needs Plan directory. This plan is offered in Missouri. Plan availability can vary by county.
More Dual Eligible Special Needs Plan options
These plans are offered in at least one of the same states. Check your ZIP or county before choosing a plan.
- Humana Gold Plus SNP-DE H0028-015 (HMO-POS D-SNP)Humana · H0028-015Offered in Missouri
- Humana Gold Plus SNP-DE H4461-044 (HMO-POS D-SNP)Humana · H4461-044Offered in Missouri
- HumanaChoice SNP-DE H7617-006 (PPO D-SNP)Humana · H7617-006Offered in Missouri
- Aetna Medicare Dual (HMO D-SNP)Aetna Medicare · H5325-004Offered in Missouri
- Aetna Medicare Dual (HMO D-SNP)Aetna Medicare · H5325-005Offered in Missouri
- Aetna Medicare Dual (HMO D-SNP)Aetna Medicare · H5325-006Offered in Missouri
Common questions
6 answers about this plan
What does HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) cover?
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) is a Dual Eligible Special Needs Plan, a Medicare Advantage plan for people who have Medicare and a Medicaid category the plan accepts. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 5 formulary tiers. Published supplemental benefits include dental ($3,000/yr preventive & comprehensive dental allowance), vision ($250/yr eyewear allowance), hearing ($0 copay per hearing aid), and over-the-counter (OTC) ($110/month OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.
Learn about Medicare AdvantageHow much does HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) cost in 2027?
The published 2027 monthly plan premium for HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) is $0. Any Medicare premiums you owe are separate from the listed plan premium. The listed Part D deductible is $200. The in-network medical out-of-pocket maximum is $9,850; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits 20%. Member costs can depend on the Medicaid category the plan accepts and verifies. These figures are plan data, not a personal yearly-cost estimate.
Understand Medicare drug-cost limitsCan I use my current doctors with HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO)?
CMS lists HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) as a Local PPO plan. The plan record says specialist referrals are not required. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.
Check your doctorsDo I qualify for HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO)?
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) is listed in the current plan record as a D-SNP. You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.
Learn about Medicare Savings ProgramsWhat extra benefits does HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) offer for dual-eligible members?
The current plan record for HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) lists dental ($3,000/yr preventive & comprehensive dental allowance), vision ($250/yr eyewear allowance), hearing ($0 copay per hearing aid), over-the-counter (OTC) ($110/month OTC allowance), and fitness ($0 fitness benefit). Member costs can depend on the Medicaid category the plan accepts and verifies. The record identifies Part D prescription drug coverage. Review the plan documents for benefit limits, eligibility rules, and how Medicare and Medicaid coverage work together.
When can I enroll in HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO)?
HumanaChoice SNP-DE H5216-164 (PPO D-SNP) (Local PPO) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a D-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.
Review Medicare enrollment periodsPlan documents
Summary of Benefits and Evidence of Coverage
- Summary of Benefits (PDF)Download the plan's official Summary of Benefits document
- Evidence of Coverage (PDF)Complete plan details and rules
- Check Your DoctorsSee if your doctors accept this plan
- Documentos en españolLlame a The Pocket Protector al 1-866-764-3312 (TTY: 711) para recibir ayuda con documentos en español
Enter your ZIP code to see how you can enroll
Enrollment options depend on where you live. Enter your ZIP code so we can show the right ways to enroll in this plan.