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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 2025, 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 2025.
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 $64.00. 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 $590.00 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 has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For example, in the initial coverage phase, preferred generic drugs have a $15 copay at preferred pharmacies and standard mail order, and a $20 copay at standard pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-032 (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. It also provides benefits for emergency services, primary care with copays as low as $5, and preventive services with no copay for an annual physical exam. Additional benefits include coverage for hearing, vision, and dental services with copays and coinsurance, as well as home health and skilled nursing facility services. The plan also covers medical equipment, diagnostic and radiological services, and ambulance services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by the HumanaChoice H5216-032 (PPO) plan, with a copay of $360 for days 1-5 and no copay for days 6-90 for acute care, and a copay of $318 for days 1-5 and no copay for days 6-90 for psychiatric care. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $360, Observation Services with a $360 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $40 and $45 for both 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 by the HumanaChoice H5216-032 (PPO) plan, with a $40 copay. Prior authorization is required.
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 $265 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the HumanaChoice H5216-032 (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay. There is no coinsurance for any of these services.
Primary Care See details
Under the HumanaChoice H5216-032 (PPO) plan, primary care physician services have a $5 copay, chiropractic services have a $15 copay, occupational therapy services have a copay between $30 and $35, and physician specialist services have a $45 copay. Mental health and psychiatric services have a $45 copay, and physical therapy and speech-language pathology services have a copay between $30 and $35. Additional telehealth benefits have a copay between $0 and $45, and opioid treatment program services have a copay between $40 and $45. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5216-032 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, and the plan also covers Fitness Benefit with no copay.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams are covered with no copay for one exam per year. Fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with a copay between $699 and $999 for two hearing aids per year, while OTC hearing aids, and prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $45, and routine eye exams have no copay; eyewear has no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-032 (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services with a $500 maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventative dental services have no copay. Restorative services and prosthodontics (removable and fixed) have no copay, with 30-40% coinsurance. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-032 (PPO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the HumanaChoice H5216-032 (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $360, Therapeutic Radiological Services have a $45 copay, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-032 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-032 (PPO), but the plan does not cover any of the sub-services, including 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. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-032 (PPO), with a $0 copay for days 1-20 and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture and meal benefits. Acupuncture has a $45 copay and is limited to 20 treatments per year, while meal benefits have no copay.
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