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HumanaChoice H5216-034 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-034 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-034 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-034 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Arizona. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-034 (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 H5216-034 (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 H5216-034 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $114.00. 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 $11400.00 (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 $11400.00 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 H5216-034 (PPO) plan offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $615.00. If you qualify for the Low-Income Subsidy, your Part D premium is reduced from $104.50 to $87.50. During the initial coverage phase, Tier 1 preferred generics have a copay as low as $5.00, while Tier 2 standard generics require a $47.00 copay. For higher-tier medications, you will pay a 40% coinsurance for Tier 3 preferred brands and a 25% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for your covered Medicare Part D prescriptions.
Additional Benefits
The HumanaChoice H5216-034 (PPO) plan offers robust coverage with no copay and no coinsurance for primary care, routine preventive services, home health care, and outpatient x-rays. For more intensive care, inpatient hospital stays require a daily copay of $470 for acute stays and $405 for psychiatric stays for the first five days, after which there is no copay. Emergency room visits carry a $115 copay, which is waived if you are admitted, while specialist visits range from no copay to a $55 copay. Routine dental, vision, and hearing exams are highly accessible with no copay or coinsurance, although prescription hearing aids require a copay of $699 to $999. For specialized medical needs, durable medical equipment and dialysis services require coinsurance ranging from 10% to 20% with no copay. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days, followed by a daily copay of $218 for days 21 through 100.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HumanaChoice H5216-034 (PPO) with no coinsurance, requiring a daily copay of $470 for days 1 to 5 of acute stays and $405 for days 1 to 5 of psychiatric stays, with no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5216-034 (PPO) with no coinsurance, though copays vary depending on the service. You will pay no copay for ambulatory surgical center and outpatient blood services, $25 to $35 for outpatient substance abuse sessions, and between $0 and $470 for outpatient hospital and observation services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by HumanaChoice H5216-034 (PPO) with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HumanaChoice H5216-034 (PPO), as transportation to plan-approved and other health-related locations is not covered. Covered ground ambulance services require a $335 copay with no coinsurance, while air ambulance services require a $1,250 copay with no coinsurance.
Emergency Services See details
HumanaChoice H5216-034 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if 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 H5216-034 (PPO) covers primary care physician services with no copay and no coinsurance, while other specialist and therapy services require copays ranging from $0 to $55 with no coinsurance. This benefit is partially covered, as routine chiropractic care is not covered.
Preventive Services See details
HumanaChoice H5216-034 (PPO) partially covers preventive services with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and fitness benefits. However, several supplemental services are not covered under this plan, including health education, weight management, alternative therapies, and caregiver support.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-034 (PPO), offering routine hearing exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $55 copay and no coinsurance. Up to two prescription hearing aids (all types) are covered annually with a $699 to $999 copay and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-034 (PPO) vision services are partially covered, featuring no copay, no coinsurance, and no deductible for routine eye exams, contact lenses, and complete eyeglasses. Other eye exams require a copay of $0 to $55, while separate eyeglass lenses, eyeglass frames, and upgrades are not covered. Prior authorization is required, and annual maximum benefits of $75 for exams and $100 for eyewear apply.
Dental Services See details
HumanaChoice H5216-034 (PPO) partially covers dental services, offering preventive care like oral exams, cleanings, and x-rays with no copay and no coinsurance, while Medicare-covered dental services require a $55 copay and no coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Other services like restorative care, endodontics, and periodontics are offered as optional supplemental benefits that may require an additional cost.
Home Infusion bundled Services See details
HumanaChoice H5216-034 (PPO) covers home infusion bundled services with prior authorization. Under this plan, Medicare Part B chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-034 (PPO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization is required for these covered services.
Medical Equipment See details
HumanaChoice H5216-034 (PPO) covers durable medical equipment with a 15% coinsurance and no copay, and diabetic supplies with a 10% to 20% coinsurance and no copay. Prosthetic devices are covered with a 20% coinsurance, diabetic therapeutic shoes or inserts require a $10 copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by HumanaChoice H5216-034 (PPO) with prior authorization. Outpatient X-rays and lab services have no copay or coinsurance, while diagnostic tests cost between $0 and a $264 copay with no coinsurance, diagnostic radiological services cost up to a $300 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-034 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-034 (PPO) does not cover Cardiac Rehabilitation Services, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by HumanaChoice H5216-034 (PPO) with prior authorization required, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-034 (PPO) partially covers other services, providing acupuncture with a $55 copay and no coinsurance for up to 20 treatments annually, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter items and dual eligible SNPs with highly integrated services are not covered.
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