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Humana Full Access H5216-011 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-011 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5216-011 (PPO) in 2026, please refer to our full plan details page.
Humana Full Access H5216-011 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Michigan. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Full Access H5216-011 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Full Access H5216-011 (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Full Access H5216-011 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5700.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5700.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Full Access H5216-011 (PPO) Medicare plan has an annual drug deductible of $300. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $10 for a 1-month supply at standard pharmacies, while a 3-month supply through preferred mail order has no copay. Tier 3 preferred brand drugs have a $47 copay for a 1-month supply at standard pharmacies and mail order services. For higher-tier medications, Tier 4 non-preferred drugs require a 50% coinsurance, and Tier 5 specialty drugs carry a 29% coinsurance.
Additional Benefits
The Humana Full Access H5216-011 (PPO) plan offers comprehensive medical coverage, featuring primary care visits, home health services, and annual preventive care with no copay and no coinsurance. For specialized care, members pay a $45 copay for specialist visits and a $130 copay for emergency room services, which is waived if admitted. Inpatient hospital stays require a $350 daily copay for the first six days, transitioning to no copay for days 7 through 90. This plan also includes valuable everyday wellness benefits, such as routine dental, vision, and hearing exams with no copay. Dental services are covered up to a $3,000 annual limit, while eyewear has a $300 annual limit, and over-the-counter hearing aids are provided with no copay. Additionally, members can access over-the-counter items and chronic illness meals with no copay, though prior authorization may be required for certain services.
Inpatient Hospital See details
Humana Full Access H5216-011 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 6 and no copay for days 7 through 90. Non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Humana Full Access H5216-011 (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a $0 to $350 copay, observation services have a $350 copay per stay, and outpatient substance abuse sessions have a $35 copay, with prior authorization required for these benefits.
Partial Hospitalization See details
Humana Full Access H5216-011 (PPO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Full Access H5216-011 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, although prior authorization is required. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Full Access H5216-011 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Full Access H5216-011 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Therapy services have a $10 to $40 copay and no coinsurance, mental health sessions require a $35 copay and no coinsurance, and while some chiropractic services are covered, routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Humana Full Access H5216-011 (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs. Additional preventive benefits are partially covered, offering a memory fitness program with no copay and no coinsurance, but excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling.
Hearing Services See details
Humana Full Access H5216-011 (PPO) covers hearing exams with no coinsurance, requiring a $45 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $99 to $699, though inner ear, outer ear, and over the ear types are not covered. Over-the-counter (OTC) hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Humana Full Access H5216-011 (PPO) partially covers vision services with no coinsurance and no deductible, offering routine exams, contacts, and eyeglasses with no copay, though other exams carry a copay up to $45. A $300 annual limit applies to eyewear, and other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Full Access H5216-011 (PPO) partially covers dental services up to a $3,000 annual limit, featuring a $45 copay and no coinsurance for Medicare-covered dental, no copay and no coinsurance for preventive and most comprehensive services, and a 30% coinsurance with no copay for prosthodontics. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Humana Full Access H5216-011 (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance, while chemotherapy and other Part B drugs carry no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Full Access H5216-011 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Full Access H5216-011 (PPO) covers medical equipment, including durable medical equipment and prosthetics which require a 20% coinsurance and no copay. Covered diabetic supplies carry a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a copay of $0 to $10.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Full Access H5216-011 (PPO) with prior authorization required. Diagnostic services feature no coinsurance, offering lab services and diagnostic radiology with no copay and diagnostic procedures with a copay ranging from $0 to $100, while radiological services include outpatient X-rays with no copay and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Full Access H5216-011 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Full Access H5216-011 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
Humana Full Access H5216-011 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 through 20 and a $218 daily copayment for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Full Access H5216-011 (PPO) partially covers other services, offering acupuncture for a $45 copay and no coinsurance (up to 20 treatments per year) with prior authorization required. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though prior authorization is required for meals and certain other miscellaneous services are not covered.
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