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HumanaChoice H5216-032 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-032 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-032 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-032 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Illinois, Kansas and Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-032 (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 H5216-032 (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 H5216-032 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $63.00. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 H5216-032 (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you pay no copay for a 1-month or 3-month supply at standard pharmacies and preferred mail order. Tier 2 generic drugs require a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, with no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, while a 3-month supply costs $131 through preferred mail order and $141 at standard pharmacies. For Tier 4 non-preferred drugs, you will pay a 36% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply across standard pharmacies and mail order options.
Additional Benefits
The HumanaChoice H5216-032 (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, annual physical exams, and home health services. For specialist visits, patients will pay a $45 copay with no coinsurance, while emergency room visits require a $115 copay. Inpatient acute hospital stays feature a $360 daily copay for the first five days and no copay for subsequent days, with no coinsurance required. Ancillary benefits include routine hearing and vision exams with no copay, alongside preventive dental care that features no copay and no coinsurance up to a $500 annual limit. Diagnostic lab services and outpatient X-rays are also available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, covered Medicare Part B drugs carry a 0% to 20% coinsurance with no copay.
Inpatient Hospital See details
HumanaChoice H5216-032 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $360 copay per day for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays require a $318 copay per day for days 1 through 5 and no copay for days 6 through 90. Some services are not covered under this benefit, including upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5216-032 (PPO) with no coinsurance, though prior authorization is required for most services. Patients will pay no copay for ambulatory surgical center and outpatient blood services, a $0 to $300 copay for outpatient hospital services, a $360 copay per stay for observation services, and a $30 to $35 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
HumanaChoice H5216-032 (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 H5216-032 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-032 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are 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 H5216-032 (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Mental health, psychiatric, and physical therapy services require copays ranging from $30 to $35 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice H5216-032 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes training, digital rectal exams, and EKGs. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-032 (PPO) covers Medicare-covered hearing exams for a $45 copay and routine exams and fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two aids yearly, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-032 (PPO) provides partially covered vision services with no coinsurance, featuring a $0 to $45 copay for eye exams and no copay for covered eyewear. While one annual routine eye exam (up to $75) and one annual pair of eyeglasses or contact lenses (up to $100) are covered, other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-032 (PPO) dental services are partially covered up to a combined $500 annual limit, offering preventive care, endodontics, and oral surgery with no copay and no coinsurance. Medicare-covered dental services require a $45 copay and no coinsurance, while covered restorative and prosthodontic services have no copay and a 30% to 40% coinsurance. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-032 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, 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 by HumanaChoice H5216-032 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-032 (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 therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-032 (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests carry a copay ranging from $0 to $100, and therapeutic radiological services require a minimum copay of $45.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-032 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-032 (PPO) with no coinsurance and required prior authorization, although only 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 in practice, carrying copayments that range from $15 to $30.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-032 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior 3-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5216-032 (PPO), featuring acupuncture with a $45.00 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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