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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 2026, 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 2026.
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 $38.00. 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 $615.00 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) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $5 for a 1-month supply at standard pharmacies and preferred mail order, and you pay no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with a 3-month supply costing $131 through preferred mail order or $141 through standard pharmacies and standard mail order. Tier 4 non-preferred drugs require a 50% coinsurance for both 1-month and 3-month supplies across all pharmacy and mail order channels. Finally, Tier 5 specialty tier drugs carry a 25% coinsurance for a 1-month supply through standard pharmacies as well as preferred and standard mail order.
Additional Benefits
The HumanaChoice H5216-014 (PPO) plan offers robust coverage with no copay for primary care visits, preventive services, and home health care. For specialized medical care, members pay a $40 copay for specialist visits, while outpatient hospital services carry a copay ranging from $0 to $300. Inpatient hospital stays require a daily copay of $360 for the first five days of acute care, with no coinsurance or copays for the remaining covered days. This plan also features valuable everyday benefits, including routine hearing and vision exams with no copay, a $100 annual eyewear allowance, and up to $500 in dental coverage with no copay for most preventive services. For emergency situations, emergency room visits have a $115 copay, which is waived if you are admitted, while durable medical equipment is covered with a 20% coinsurance. Overall, the plan minimizes out-of-pocket expenses by offering many essential services with no copayments or coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-014 (PPO) covers inpatient hospital services with no coinsurance, requiring a $360 daily copay for days 1-5 of acute stays and a $318 daily copay for days 1-5 of psychiatric stays, followed by no copay for remaining covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-014 (PPO) covers outpatient services with no coinsurance, although prior authorization is required. Under this plan, ambulatory surgical center and blood services have no copay, while outpatient hospital services carry a $0 to $300 copay ($360 per stay for observation) and outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-014 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-014 (PPO) covers ground ambulance services with a $335.00 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Emergency services under HumanaChoice H5216-014 (PPO) are covered with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed care is covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-014 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, and speech therapy require a $35 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-014 (PPO) offers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. However, these additional benefits are only partially covered, as the plan excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and nutritional/dietary benefits.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-014 (PPO) with no deductibles, offering annual routine exams and fitting evaluations with no copay and no coinsurance. Medicare-covered exams require a $40 copay and no coinsurance, while prescription hearing aids have a $699 to $999 copay and no coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-014 (PPO) vision services are partially covered, offering one routine eye exam and a $100 annual eyewear allowance with no copays, no coinsurance, and no deductibles. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-014 (PPO) up to a $500 annual maximum, offering no copay and no coinsurance for most preventive, diagnostic, endodontic, and oral surgery services. Medicare-covered dental requires a $40 copay with no coinsurance, restorative and prosthodontic services require a 30% to 40% coinsurance with no copay, and fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-014 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B chemotherapy and other drugs carry no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-014 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice H5216-014 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies require a 10% to 20% coinsurance and no copay, while diabetic shoes or inserts have a $10 copay and no coinsurance, with prior authorization required for all equipment.
Diagnostic and Radiological Services See details
HumanaChoice H5216-014 (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays have no copay, while diagnostic procedures carry a copay of $0 to $95 and therapeutic radiological services have a copay starting at $40.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-014 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the HumanaChoice H5216-014 (PPO) plan require prior authorization with no copay and no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-014 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-014 (PPO) provides partial coverage for other services, including acupuncture for a $40 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered services, while over-the-counter (OTC) items are not covered.
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