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HumanaChoice H5216-039 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-039 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-039 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-039 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Northern Nevada Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-039 (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 H5216-039 (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 H5216-039 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $800.00 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 $8950.00 (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 $8950.00 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 H5216-039 (PPO) plan has an annual drug deductible of $615 before coverage begins. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. If you choose standard mail order for these generic tiers, copays range from $10 to $20 for a 1-month supply. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail order services, with preferred mail order reducing the 3-month supply copay to $94. Higher-tier medications require coinsurance instead of flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. Understanding these copays and coinsurance rates can help you estimate your out-of-pocket prescription costs under this Medicare plan.
Additional Benefits
The HumanaChoice H5216-039 (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, including no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, occupational therapy, and physical therapy require a $35 copay with no coinsurance, while emergency room visits have a $130 copay. For hospital stays, inpatient care is covered with a $395 daily copay for the first five days and no copay for days six through 90. This plan also features robust supplemental benefits, including routine dental care with no copay or coinsurance up to a $1,750 annual limit. Routine vision exams and a $250 annual eyewear allowance are covered with no copays, deductibles, or coinsurance, and routine hearing exams and over-the-counter hearing aids require no copay. Members also enjoy additional perks like no-copay over-the-counter items and chronic illness meal benefits.
Inpatient Hospital See details
HumanaChoice H5216-039 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $395 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Prior authorization is required, and while unlimited additional acute hospital days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-039 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $25 to $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice H5216-039 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-039 (PPO) covers ground ambulance services with a $285 copay and air ambulance services with a $1,250 copay, both featuring no coinsurance. While transportation services are covered, trips to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-039 (PPO) covers emergency services with a $130 copay, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent care, and emergency transportation services are also covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-039 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and physical therapy require a $35 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services feature copays ranging from $25 to $35 with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by HumanaChoice H5216-039 (PPO) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs. However, 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, tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-039 (PPO) covers hearing services with no copay and no coinsurance for OTC hearing aids, annual routine hearing exams, and fitting evaluations, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over-the-ear prescription hearing aids.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-039 (PPO) with no deductibles, no coinsurance, and no copays for one annual routine eye exam and a $250 annual allowance for contact lenses or eyeglasses. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-039 (PPO), offering a $1,750 annual maximum benefit with no copay and no coinsurance for most diagnostic, preventive, and restorative services. Medicare-covered dental services require a $35 copay and no coinsurance, prosthodontics require a 30% coinsurance and no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-039 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice H5216-039 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-039 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance, no copay, and prior authorization requirements. Diabetic supplies require a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts have a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H5216-039 (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic procedures and tests range from no copay up to a $150 copay with no coinsurance, while lab services, diagnostic radiological services, and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-039 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-039 (PPO) offers Cardiac Rehabilitation Services with no copay, no coinsurance, and prior authorization required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-039 (PPO) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
HumanaChoice H5216-039 (PPO) covers acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year, which requires prior authorization. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, although the meal benefit requires prior authorization.
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