HumanaChoice SNP-DE H5216-331 (PPO D-SNP)

HumanaChoice SNP-DE H5216-331 (PPO D-SNP), plan H5216-331-000, is a 2027 Medicare Advantage plan from Humana, sold in Oklahoma. It carries a $0 plan premium with a $9,850 in-network out-of-pocket limit.

This is a dual eligible special needs plan, which means you qualify only if you have both Medicare and help from your state Medicaid program. Which Medicaid category you are in decides whether you can join and what you pay, so that is the first thing to have checked. If your Medicaid status changes, your eligibility for this plan can change with it.

CMS records this plan as a zero-dollar cost sharing dual plan. For members who qualify at that level, you pay nothing for covered medical services, so the copays listed further down this page would not apply to you. Your state coverage picks up what Medicare does not.

CMS classifies it as Coordination Only (CO). Coordination-only plans cover your Medicare benefits and coordinate with your state coverage, but the two stay separate, so you will deal with both.

Keep both cards and show both at every appointment. The plan card covers your Medicare benefits, and the state card covers what it covers, which commonly includes long-term services, transport and dental work beyond the plan's own allowance. Showing only one card is the usual reason a dual member gets a bill they should not have received.

If a bill does arrive, do not pay it before you call. Providers who bill a qualified dual member for Medicare cost sharing are generally not allowed to, and the plan can sort it out with the provider's office.

In network, a primary care visit is 20% coinsurance, a specialist visit is 20% coinsurance, the emergency room is $115 and urgent care is 20% coinsurance. Emergency care and urgently needed services are covered whether or not the provider is in the plan's network, which matters when you are away from home.

An individual mental health visit is 20% coinsurance and occupational therapy is 20% coinsurance.

Physical therapy and speech therapy are covered too, at cost shares the plan lists in its Summary of Benefits rather than in the CMS benefit files, so check those two there.

You pay $0 for the preventive services Original Medicare covers when you use a provider in the plan's network. That includes your annual wellness visit, the recommended screenings for your age, and most vaccines. Preventive care is the easiest value to collect from any Medicare Advantage plan, so book the wellness visit early in the year.

Beyond what Original Medicare covers, this plan includes $425 toward glasses or contacts. These allowances almost always have to be used with providers and suppliers the plan works with, so check that before you buy, particularly for hearing aids where the plan usually names its own vendor.

The eyewear allowance covers eyeglasses or contact lenses, and it resets each plan year rather than rolling over, so an unused allowance is lost at the end of December.

Part D prescription drug coverage is included, so you do not need a separate drug plan. Check the plan's formulary, which is its list of covered drugs, for every medicine you take before you enroll.

For 2027, the drug deductible is $550 and your own drug costs are capped at $2,400 for the year.

The plan sorts drugs into 4 tiers, and what you pay depends on the tier and on which pharmacy you use. The tier table below shows the cost at a preferred retail pharmacy, a standard retail pharmacy, and by mail. Because drug coverage is built in, you do not add a standalone prescription drug plan on top.

If a medicine you take is not on the formulary, your prescriber can ask the plan for an exception, and if your income is limited, Extra Help can cut what you pay for drugs regardless of which plan you choose.

Some care on this plan needs prior authorization, which means Humana has to approve it before you get it. Specialist services are among those that do. Your doctor's office usually files the request, but the plan may not pay if the approval is skipped, so confirm it is in hand before a scheduled procedure. The plan's evidence of coverage lists every service that needs it.

Here is how HumanaChoice SNP-DE H5216-331 (PPO D-SNP) sits against other plans sold in Oklahoma County for 2027.

Humana USAA Honor Giveback (PPO) has a lower in-network limit at $4,700. Humana USAA Honor Giveback (PPO) rates higher at 4.5 stars.

This plan may fit people in the service area who want a $0 plan premium and are comfortable with a $9,850 ceiling on in-network costs. It is built for people who have both Medicare and state Medicaid coverage, so it is not a fit if you do not.

Like any Medicare Advantage plan, it changes how your Medicare claims are paid. If you travel often, or you want to use any doctor who accepts Medicare without checking a network, compare it against Original Medicare with a Medicare Supplement and a separate drug plan before you decide.

A licensed insurance agent can check all of these against your own doctors and prescriptions at no cost.