Humana Dual Select H5216-361 (PPO D-SNP)
Humana Dual Select H5216-361 (PPO D-SNP) H5216-361 Plan Details
Humana Dual Select H5216-361 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-361
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$0.00
Monthly Premium
Humana Dual Select H5216-361 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-361
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Humana Dual Select H5216-361 (PPO D-SNP) H5216-361 Plan Details
Humana Dual Select H5216-361 (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-361
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$0.00
Monthly Premium
Arkansas Counties Served
Carroll
Madison
Washington
Johnson
Sebastian
Benton
Crawford
Franklin
Logan
Grant
Montgomery
Calhoun
Clark
Hot Spring
Scott
Garland
Saline
Lonoke
Perry
Pulaski
Cleburne
Conway
Van Buren
Faulkner
Saint Francis
Prairie
Yell
Stone
Pope
Crittenden
Lee
Mississippi
Randolph
Poinsett
Lawrence
Greene
Craighead
Newton
Baxter
Marion
Mccurtain
Boone
Searcy
Nevada
Bradley
Jefferson
Cleveland
Lincoln
Le Flore
Desha
Chicot
Dallas
Union
Pike
Arkansas
Phillips
Izard
Fulton
Ashley
Columbia
Hempstead
Little River
Ouachita
Sevier
Miller
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $5700 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 Out-of-Network: Doctor Office Visit Services: Copayment for Medicare Covered Primary Care Office Visit $0 |
| Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0 or $20 Out-of-Network: Doctor Specialty Visit Services: Copayment for Medicare Covered Physician Specialist Office Visit $0 or $25 |
| Inpatient Hospital Care | 0 or $In-Network: Acute Hospital Services: $325 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services Prior authorization required 0 or $ Out-of-Network: Acute Hospital Services: $500 per day for days 1 to 10 $0 per day for days 11 to 90 |
| Urgent Care | Copayment for Urgent Care $0 or $55 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 or $125 |
| Emergency Room Visit | Copayment for Emergency Care $0 or $125 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $0 or $125 Copayment for Worldwide Emergency Transportation $0 or $125 |
| Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $0 or $315 Air Ambulance: Copayment for Air Ambulance Services $0 or $315 Prior Authorization Required for Air Ambulance Prior authorization required Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $0 or $315 Copayment for Medicare Covered Ambulance Services - Air $0 or $315 |
Health Care Services and Medical Supplies
Humana Dual Select H5216-361 (PPO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Copayment for Medicare-covered Chiropractic Services $0 or $15 Prior Authorization Required for Chiropractic Services Prior authorization required Out-of-Network: Medicare Covered Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $0 or $15 |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Copayment for Medicare-covered Diabetic Supplies $0 or 0 Coinsurance for Medicare-covered Diabetic Supplies 0 or 20% Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 0% or 20% Out-of-Network: Medicare Covered Diabetic Supplies and Services: Copayment for Medicare Covered Diabetic Supplies $0 or 0 Coinsurance for Medicare Covered Diabetic Supplies 0 or 20% Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 0% or 20% |
| Durable Medical Eqipment (DME) | In-Network: Copayment for Medicare-covered Durable Medical Equipment $0 or 0 Coinsurance for Medicare-covered Durable Medical Equipment 0 or 20% Prior Authorization Required for Durable Medical Equipment 20% Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy20% DME - DME Prov20% DME - Pharmacy Prior authorization required Out-of-Network: Medicare Covered Durable Medical Equipment Services: Copayment for Medicare Covered Durable Medical Equipment $0 or 0 Coinsurance for Medicare Covered Durable Medical Equipment 0 or 20% 20% Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy20% DME - DME Prov20% DME - Pharmacy |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $55 Copayment for Medicare-covered Lab Services $0 to $55 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services $20 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$20 OP Diag Proc & Tests - SPC$55 OP Diag Proc & Tests - UCC$20 Sleep Study (Fac Based) - OPH$20 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 or 200 to $325 Coinsurance for Medicare-covered Diagnostic Radiological Services 0 or 20% Coinsurance for Medicare-covered Therapeutic Radiological Services 0% or 20% Copayment for Medicare-covered X-Ray Services $0 to $130 Prior authorization required Out-of-Network: Medicare Covered Diagnostic Procedures/Tests Services: Copayment for Medicare Covered Diagnostic Procedures/Tests $0 to $55 Copayment for Medicare Covered Lab Services $0 to $55 Coinsurance for Medicare Covered Diagnostic Radiological Services 0% or 20% Coinsurance for Medicare Covered Therapeutic Radiological Services 0% or 20% Copayment for Medicare Covered Outpatient X-Ray Services $0 to $130 $20 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$20 OP Diag Proc & Tests - SPC$55 OP Diag Proc & Tests - UCC$20 Sleep Study (Fac Based) - OPH$20 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home |
| Home Health Care | In-Network: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services Prior authorization required Out-of-Network: Medicare Covered Home Health Services: Copayment for Medicare Covered Home Health $0 |
| Mental Health Inpatient Care | 0 or $In-Network: Psychiatric Hospital Services: $325 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required 0 or $ Out-of-Network: Psychiatric Hospital Services: $500 per day for days 1 to 10 $0 per day for days 11 to 90 |
| Mental Health Outpatient Care | In-Network: Copayment for Medicare-covered Individual Sessions $0 or $40 Copayment for Medicare-covered Group Sessions $0 or $40 Out-of-Network: Medicare Covered Mental Health Services: Copayment for Medicare Covered Individual Sessions $0 or $40 Copayment for Medicare Covered Group Sessions $0 or $40 |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 or 100 to $370 Coinsurance for Medicare Covered Outpatient Hospital Services 0 or 20% Prior Authorization Required for Outpatient Hospital Services 20% Diag Colonoscopy - OPH$100 Mental Health - OPH$370 Surgery Svcs - OPH20% Wound Care - OPH Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $0 or $325 Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 or 310 Coinsurance for Ambulatory Surgical Center Services 0 or 20% Prior Authorization Required for Ambulatory Surgical Center Services 20% Diag Colonoscopy - ASC$310 Surgery Svcs - ASC Prior authorization required Out-of-Network: Medicare Covered Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 or 100 to $370 Coinsurance for Medicare Covered Outpatient Hospital Services 0 or 20% Copayment for Medicare Covered Ambulatory Surgical Center Services $0 or 310 Coinsurance for Medicare Covered Ambulatory Surgical Center Services 0 or 20% 20% Diag Colonoscopy - OPH$100 Mental Health - OPH$370 Surgery Svcs - OPH20% Wound Care - OPH |
| Outpatient Substance Abuse Care | In-Network: Copayment for Medicare-covered Individual Sessions $0 or $40 to $100 Copayment for Medicare-covered Group Sessions $0 or $40 to $100 Prior Authorization Required for Outpatient Substance Abuse Services $100 OP Substance Abuse Care - OPH$40 OP Substance Abuse Care - SPC Prior authorization required Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $0 or $40 to $100 Copayment for Medicare Covered Group Sessions $0 or $40 to $100 $100 OP Substance Abuse Care - OPH$40 OP Substance Abuse Care - SPC |
| Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0
|
| Podiatry Services | In-Network: Copayment for Medicare-Covered Podiatry Services $0 or $20 Prior Authorization Required for Podiatry Services Prior authorization required Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $0 or $25 |
| Skilled Nursing Facility Care | 0 or $0 or $In-Network: Skilled Nursing Facility Services: $10 per day for days 1 to 20 $214 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services Prior authorization required 0 or $0 or $ Out-of-Network: Skilled Nursing Facility Services: $10 per day for days 1 to 20 $214 per day for days 21 to 100 |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | $0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for comprehensive oral evaluation or periodontal exam, occlusal adjustment, scaling for moderate inflammation up to 1 every 3 years. $0 copayment for bridge recementation, bridges-pontic, crown recementation, panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bridges-crown up to 2 every 5 years. $0 copayment for crown, other restorative services - core buildup and prefabricated post and core, root canal, root canal retreatment up to 1 per tooth per lifetime. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for emergency treatment for pain, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for amalgam and/or composite filling, necessary anesthesia with covered service, simple or surgical extraction up to unlimited per year. $1,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.Out of Network$0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for comprehensive oral evaluation or periodontal exam, occlusal adjustment, scaling for moderate inflammation up to 1 every 3 years. $0 copayment for bridge recementation, bridges-pontic, crown recementation, panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bridges-crown up to 2 every 5 years. $0 copayment for crown, other restorative services - core buildup and prefabricated post and core, root canal, root canal retreatment up to 1 per tooth per lifetime. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for emergency treatment for pain, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for amalgam and/or composite filling, necessary anesthesia with covered service, simple or surgical extraction up to unlimited per year. $1,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 to $20 Copayment for Routine Eye Exams $0
Eyewear: Copayment for Medicare-Covered Benefits $0 Copayment for Contact Lenses $0
Members must use Humana's Medicare Insight Network, a national network of providers, which includes standard or PLUS providers. The allowance for the standard network is $50 less than the PLUS network. Out-of-Network: Medicare Covered Eye Exams Services: Copayment for Medicare Covered Eye Exams $0 to $25 Copayment for Medicare Covered Eyewear $0 |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $0 or $20 Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $0
Prior authorization required Out-of-Network: Medicare Covered Hearing Exams Services: Copayment for Medicare Covered Hearing Exams $0 or $25 |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0 |
