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HumanaChoice H5216-048 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-048 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-048 (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
HumanaChoice H5216-048 (PPO) is a PPO plan offered by Humana Insurance Company available for the 2026 plan year to people living in Select Counties in ID, MT, OR, UT, WA, WY. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-048 (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 H5216-048 (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 H5216-048 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $87.00. 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 $100.00 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 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:
Sign up for HumanaChoice H5216-048 (PPO)
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Drug Coverage
The HumanaChoice H5216-048 (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, and no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, though you can save on a 3-month supply by using preferred mail order for $131 instead of the standard $141. For higher-tier medications, Tier 4 non-preferred drugs require a 40% coinsurance, and Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply. These structured costs make it easy to plan your healthcare budget based on your specific prescription needs.
Additional Benefits
The HumanaChoice H5216-048 (PPO) plan offers robust coverage for everyday medical needs, featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. If you need specialist care, visits require a $35 copay, while inpatient hospital stays have a $325 daily copay for the first four days followed by no copay for days five through ninety. Emergency care is available with a $130 copay, which is waived upon hospital admission, and urgent care visits require a $50 copay. This plan also includes valuable supplemental benefits, offering preventive dental care, routine eye exams, and routine hearing exams with no copay. Dental services are covered up to a $1,000 annual limit, while prescription hearing aids require a copay of $699 to $999. Diagnostic lab services and home infusion services are also covered with no copay, ensuring affordable access to essential medical support.
Inpatient Hospital See details
HumanaChoice H5216-048 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $325 daily copay for days 1 to 4, followed by no copay for days 5 to 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-048 (PPO) covers outpatient hospital services with a copay of up to $35 and 20% coinsurance, and ambulatory surgical center services with no copay and 20% coinsurance. Outpatient substance abuse services are covered with no coinsurance and a copay of up to $35, while outpatient blood services require no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice H5216-048 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HumanaChoice H5216-048 (PPO) covers ambulance services with no coinsurance, requiring a $335 copay for ground transport and a $1,250 copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-048 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay per service and no coinsurance.
Primary Care See details
HumanaChoice H5216-048 (PPO) covers primary care visits, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapies have a $30 copay and no coinsurance, but podiatry is not covered, and routine and other chiropractic services are excluded.
Preventive Services See details
HumanaChoice H5216-048 (PPO) covers essential preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. While a memory fitness benefit is covered with no copay and no coinsurance, many other supplemental preventive benefits, such as health education, nutritional therapy, and in-home support services, are not covered.
Hearing Services See details
HumanaChoice H5216-048 (PPO) partially covers hearing services, offering routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a $699 to $999 copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-048 (PPO) provides partially covered vision services with no deductible, no coinsurance, and a copay ranging from no copay to $35 for eye exams and no copay for eyewear. Routine exams, contact lenses, and eyeglasses are covered up to yearly allowances, but other eye exams, standalone eyeglass lenses, standalone frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-048 (PPO) up to a $1,000 annual limit, offering no copay and no coinsurance for preventive care, endodontics, periodontics, and oral surgery, while Medicare-covered dental requires a $35 copay and no coinsurance. Restorative and fixed prosthodontics have no copay and a 30% to 40% coinsurance, but fluoride, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5216-048 (PPO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-048 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-048 (PPO) covers medical equipment, featuring a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Covered diabetic supplies have a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-048 (PPO) covers diagnostic and radiological services with prior authorization required. Lab services have no copay and no coinsurance, while diagnostic procedures have a $0 to $50 copay with no coinsurance. Outpatient X-rays feature no copay and a minimum 20% coinsurance, and other radiological services require varying copays and coinsurance.
Home Health Services See details
HumanaChoice H5216-048 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HumanaChoice H5216-048 (PPO) plan with no coinsurance, though in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, requiring prior authorization and a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits under the HumanaChoice H5216-048 (PPO) plan are covered with no coinsurance, require prior authorization, and do not require a prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 71 to 100, a $218 copay for days 21 to 70, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by HumanaChoice H5216-048 (PPO), which features acupuncture with a $35.00 copay and no coinsurance for up to 20 treatments per year, as well as a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered, and prior authorization is required for the covered services.
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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