H5216‑420 or HumanaChoice SNP-DE (PPO D-SNP)

H5216‑420 is the HumanaChoice SNP-DE plan for Wisconsin dual eligibles in 2026.

This Medicare Advantage D-SNP combines your Medicare and Medicaid benefits. It offers low costs and extra help with medical bills.

Quick Facts:

• $15.30 monthly premium plus Part B coverage
• $0 health deductible and $0 copays for Tier 1-2 drugs
• Dental, vision, and hearing benefits are included
• Care Coordinator helps manage your benefits
• Available in Brown, Milwaukee, Racine, and Waukesha counties
• 3.5 out of 5-star rating from CMS

2026 Plan Costs and Coverage Overview

This plan offers affordable coverage for people with both Medicare and Medicaid. You get help paying for doctor visits, drugs, and hospital stays.

Here are the details you need to know:

Monthly Premiums and Deductibles

You pay $15.30 each month for this plan. You also pay your Medicare Part B premium, but Medicaid might cover this cost.

Your health deductible is $0. Your drug deductible is $615, but you pay $0 for Tier 1 and Tier 2 drugs.

Out-of-Pocket Maximums

The plan protects you with yearly spending caps. You pay no more than $9,250 for in-network care.

You pay no more than $13,900 for combined in-network and out-of-network care.

Core Benefits and Features

H5216‑420 gives you more than basic Medicare coverage. You get extra benefits that keep you healthy and save you money.

The plan works as a PPO, so you can see any doctor who accepts the plan.

Prescription Drug Coverage

Your drugs are covered under Medicare Part D. You pay $0 for Tier 1 and Tier 2 medications.

This includes generic drugs at standard or preferred pharmacies.

Dental, Vision, and Hearing

The plan covers routine dental cleanings and exams. You get vision coverage for yearly eye exams and glasses.

Hearing aids and exams are also included in your benefits.

Care Coordination Support

A Care Coordinator helps you understand both Medicare and Medicaid.

They make sure you get all the benefits you qualify for. This person helps schedule appointments and manage your care.

Eligibility Requirements for 2026

You must meet special rules to join this plan. The plan is only for people who qualify for both Medicare and Medicaid.

You must also live in specific parts of Wisconsin.

Where You Must Live

You need to live in the Wisconsin service area. This includes counties like Brown, Milwaukee, Racine, and Waukesha.

You can check the exact service area on the Medicare.gov plan finder.

Medicare Requirements

You must have Medicare Part A and Part B. You must be 65 or older, or disabled, or have End-Stage Renal Disease. These are the basic Medicare rules.

Medicaid Status Levels

You need one of these Medicaid statuses. Full Benefit Dual Eligible (FBDE) gives you full Medicaid benefits.

Qualified Medicare Beneficiary (QMB or QMB+) pays your Medicare premiums and cost-sharing.

Specified Low-Income Medicare Beneficiary (SLMB or SLMB+) pays your Part B premium. Qualifying Individual (QI) also helps with Part B premiums.

You can check 2026 medicaid eligibility to see if you qualify.

New Rules for 2026 Benefits

This year brings new rules for extra benefits. You must have a verified chronic condition to get grocery or utility credits.

Your doctor must confirm conditions like diabetes, heart failure, or heart disease. This is called the SSBCI guardrail rule from CMS.

How to Enroll and When to Sign Up

You can sign up during specific times of the year. There are special rules for dual eligibles that make it easier to join. Here is when you can enroll.

Annual Enrollment Period

You can sign up from October 15 to December 7 each year. Your coverage starts on January 1. This is called the Annual Enrollment Period or AEP.

Special Enrollment for Dual Eligibles

Dual eligibles get extra chances to enroll. You can use a Special Enrollment Period once per month.

This lets you switch to an integrated D-SNP that coordinates both Medicare and Medicaid.

If you want to compare other dual plans, look at the H5216‑345 Medicare Advantage Plan for similar benefits.

Understanding Your Medicaid Options

Knowing your Medicaid status helps you pick the right plan. Different levels offer different types of help with costs. Make sure you understand your current benefits.

You should check [medicaid income limits by state 2026] to see if you qualify for Medicaid. This helps you understand if you can join this special needs plan.

Each state has different rules for income and assets based on Medicaid.gov guidelines.

You can also review the medicaid fee schedule 2026 to see what doctors get paid. This helps you understand which services are covered.

It shows the rates for different medical procedures in Wisconsin.

Frequently Asked Questions

H5216‑420 offers strong coverage for Wisconsin dual eligibles in 2026. You get low costs and extra benefits like dental and vision. Check your eligibility and enroll during the next open period.

Last Updated: January, 2026