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HumanaChoice H5216-024 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-024 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-024 (PPO) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
HumanaChoice H5216-024 (PPO) is a PPO plan offered by Humana Inc. available for the 2025 plan year to people living in Northern Ohio Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-024 (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 H5216-024 (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 H5216-024 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.00. 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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6750.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $10100.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 H5216-024 (PPO) plan has a $400 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy used. For example, in the initial coverage phase, you will pay a $15 copay for preferred generic drugs at a standard or mail order pharmacy. You will pay 45% coinsurance for preferred brand drugs.
Additional Benefits
The HumanaChoice H5216-024 (PPO) plan offers a range of benefits, including inpatient hospital stays with a $470 copay for the first few days, and outpatient services with varying copays. Primary care has a $5 copay, and specialist visits cost $55. Preventive services, like annual physical exams, have no copay. The plan also covers vision and dental services with some limitations. Hearing exams cost $55, while eyewear is covered with no copay and a combined maximum of $200 every year for contact lenses and eyeglasses. Emergency services have a $125 copay, and ambulance services cost $315.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a copay of $470 for days 1-5, and no copay for days 6-90 for acute care, and a copay of $470 for days 1-4 and no copay for days 5-90 for psychiatric care. Additional days for inpatient hospital acute care are covered with no copay, while non-Medicare-covered stays and upgrades for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $470, Observation Services with a $470 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $55 and $100 for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-024 (PPO) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
The HumanaChoice H5216-024 (PPO) plan covers ambulance services, including both ground and air ambulance, with a copay of $315. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by HumanaChoice H5216-024 (PPO). Emergency Services have a $125 copay, while Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-024 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay (prior authorization required), occupational therapy services with a copay between $15 and $40 (prior authorization required), and physician specialist services with a $55 copay. Mental health services are covered with a $55 copay for both individual and group sessions (prior authorization required), while physical therapy and speech-language pathology services have a copay between $15 and $40. Additional telehealth benefits are covered with a copay between $0 and $55, and opioid treatment program services have a copay between $55 and $100 (prior authorization required).
Preventive Services See details
The HumanaChoice H5216-024 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additionally, the plan covers several other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing services are covered by the HumanaChoice H5216-024 (PPO) plan, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered. Hearing exams have a $55 copay, and there is no coinsurance.
Vision Services See details
The HumanaChoice H5216-024 (PPO) plan covers vision services, including eye exams with a copay of $0-$55. Eyewear is covered with no copay, and a combined maximum of $200 every year for contact lenses and eyeglasses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-024 (PPO) plan covers Medicare Dental Services with a $55 copay, and offers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services with no copay. Fluoride Treatment, Restorative Services, 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, but require prior authorization. Insulin has a $35 copay and a coinsurance between 0% and 20%. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-024 (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, and medical supplies, are covered. For Durable Medical Equipment, there is a 20% coinsurance and authorization is required. Medical supplies have a 20% coinsurance. Diabetic equipment is covered with a coinsurance and copay, and Diabetic Supplies have a 10-20% coinsurance and no copay while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, with a copay that varies from $0 to $110, and lab services with no copay. Radiological services include outpatient X-ray services with a $5 copay, diagnostic radiological services with a copay up to $720, and therapeutic radiological services with a copay up to $45 and a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-024 (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 the specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A copay applies to some services, but more information is needed to determine the exact cost.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-024 (PPO), with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice H5216-024 (PPO) plan covers acupuncture with a $55 copay, limited to 20 treatments per year, and meal benefits with 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.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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