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HumanaChoice H5216-023 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-023 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-023 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-023 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in IN, KY, OH and PA. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-023 (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 H5216-023 (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 H5216-023 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.00. 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 $350.00 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 $10100.00 (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 $10100.00 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 H5216-023 (PPO) plan has a $350 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $17 copay at preferred and mail-order pharmacies, and a $20 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-023 (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You'll find no copays for preventive services, oral exams, dental x-rays, and many other services. This plan also covers ambulance and emergency services, with copays ranging from $5 to $315 depending on the service. Additionally, it includes coverage for hearing, vision, and dental services, with a mix of copays and no copay options depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered under the HumanaChoice H5216-023 (PPO) plan. For Inpatient Hospital-Acute, you will pay a $490 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $490 copay for days 1-4, and no copay for days 5-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, as are Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $440, observation services with a $490 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have copays between $55 and $100 for individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-023 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-023 (PPO) plan. Ground and Air Ambulance Services have a $315 copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by HumanaChoice H5216-023 (PPO). Emergency Services have a $125 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay and no coinsurance.
Primary Care See details
The HumanaChoice H5216-023 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay (prior authorization required), and occupational therapy services with a $15-$40 copay (prior authorization required). It also covers physician specialist services with a $55 copay, mental health specialty services with a $55 copay (prior authorization required), and physical therapy and speech-language pathology services with a $15-$40 copay (prior authorization required). This plan also covers additional telehealth benefits and opioid treatment program services.
Preventive Services See details
The HumanaChoice H5216-023 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered with a $0 minimum and maximum copay.
Hearing Services See details
Hearing Services are covered by the HumanaChoice H5216-023 (PPO) plan, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered. Hearing exams have a $55 copay.
Vision Services See details
HumanaChoice H5216-023 (PPO) covers vision services, including eye exams with a copay of $0-$55, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-023 (PPO) plan covers dental services, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, and restorative services with a $25 copay. Other services such as fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, all with coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-023 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay and a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $105, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $600, Therapeutic Radiological Services have a copay up to $45 and a coinsurance of at least 20%, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-023 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H5216-023 (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-023 (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture and a meal benefit. Acupuncture has a $55 copay and is limited to 20 treatments per year, and the meal benefit has no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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.
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