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HumanaChoice H5216-014 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-014 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-014 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-014 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Iowa and Nebraska. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-014 (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 HumanaChoice H5216-014 (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 HumanaChoice H5216-014 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.00. 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 $400.00 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 $12000.00 (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 $12000.00 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 HumanaChoice H5216-014 (PPO) plan has a $400 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For generic drugs, expect to pay a copay of $16-$47, depending on the pharmacy. For brand-name drugs, you will pay 50% coinsurance.
Additional Benefits
The HumanaChoice H5216-014 (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital care, with varying copays depending on the service. This plan also provides coverage for primary care, preventive, hearing, vision, and dental services, with a mix of copays and coinsurance. Additional benefits include ambulance services, emergency services, and home health services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you'll pay a $360 copay for days 1-5, and no copay for days 6-90; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has a $318 copay for days 1-5, and no copay for days 6-90; additional days are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $360 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay between $40 and $95 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-014 (PPO) plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice H5216-014 (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay. There is no coinsurance for any of these services.
Primary Care See details
The HumanaChoice H5216-014 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. This plan also covers physician specialist services with a $40 copay, mental health and psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a $0 - $45 copay, and opioid treatment program services with a $40 - $95 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and other preventive services. Annual physical exams and fitness benefits have no copay, while the other preventive services have varying copays.
Hearing Services See details
Hearing exams have a $40 copay, and routine hearing exams have no copay. Fitting/evaluation for hearing aids has no copay, while prescription hearing aids have a copay between $699 and $999. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $40, and eyewear has no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-014 (PPO) covers dental services, including oral exams with no copay, and dental x-rays with no copay. Other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay and coinsurance of 30% to 40% for restorative, and 30% for prosthodontics (removable and fixed). Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-014 (PPO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment is covered by the HumanaChoice H5216-014 (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Prosthetic Devices also have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with Diagnostic Procedures/Tests having a copay between $0 and $95, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $350, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $5 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-014 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but no specific services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-014 (PPO) with prior authorization required. There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services includes coverage for acupuncture with a $40 copay, and a meal benefit with no copay; however, over-the-counter items, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Acupuncture has a limit of 20 treatments per year.
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