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HumanaChoice H5216-053 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-053 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-053 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-053 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Central Indiana Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-053 (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 H5216-053 (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 H5216-053 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 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 $10100.00 (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 $10100.00 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 H5216-053 (PPO) prescription drug plan features an annual drug deductible of $200. Tier 1 preferred generic drugs are highly affordable, offering no copay at standard pharmacies and through preferred mail order for both one-month and three-month supplies. Tier 2 generic medications cost a $5 copay for a one-month supply at standard pharmacies, and you can get a three-month supply with no copay through preferred mail order. For Tier 3 preferred brand drugs, the plan charges a $47 copay for a one-month supply, while a three-month supply costs $131 via preferred mail order and $141 at standard pharmacies. Tier 4 non-preferred drugs require a 48% coinsurance for both one-month and three-month supplies across standard and preferred channels. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
The HumanaChoice H5216-053 (PPO) plan offers robust coverage for everyday medical needs, featuring no copays or coinsurance for primary care visits and routine preventive services. Specialists and urgent care visits require a $50 copay, while emergency room visits carry a $130 copay with no coinsurance. For hospital care, inpatient stays require a $430 daily copay for the first five days, whereas outpatient services feature no coinsurance and copays ranging from no copay up to $430. Additional benefits like routine vision exams, home health, and select dental services are covered with no copays or coinsurance, though dental benefits are capped at a $1,000 annual maximum. Prescription hearing aids require copays ranging from $99 to $699, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Overall, this plan minimizes coinsurance for most routine services, relying instead on predictable copayments.
Inpatient Hospital See details
HumanaChoice H5216-053 (PPO) inpatient hospital benefits are partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Covered acute and psychiatric stays require a $430 daily copay for days 1 through 5, with no copay for days 6 through 90 and no coinsurance.
Outpatient Services See details
Outpatient services covered by HumanaChoice H5216-053 (PPO) feature no coinsurance across all services, with copays ranging from $0 to $430 for outpatient hospital services and $430 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 $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice H5216-053 (PPO) plan with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HumanaChoice H5216-053 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-053 (PPO) emergency services are covered with a $130 copay and no coinsurance, which is 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 and no coinsurance.
Primary Care See details
HumanaChoice H5216-053 (PPO) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Additional benefits like therapy, mental health, and telehealth services carry copays ranging from $0 to $50 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-053 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and memory fitness. However, additional preventive services are only partially covered; excluded services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-053 (PPO) with no deductible and no coinsurance, featuring a $50 copay for Medicare-covered exams, no copay for routine exams and fitting evaluations, and a $99 to $699 copay for prescription hearing aids. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
HumanaChoice H5216-053 (PPO) offers partially covered vision services with no deductible, no coinsurance, and no copay for annual routine eye exams (up to $75) and contact lenses or eyeglasses (up to $250). Other eye exams require a copay of up to $50, while individual eyeglass lenses, eyeglass frames, upgrades, and other eye exam services are not covered.
Dental Services See details
HumanaChoice H5216-053 (PPO) dental services are partially covered, offering a $1,000 annual maximum with a $50 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-053 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs carry no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice H5216-053 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice H5216-053 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes are also covered, featuring copays ranging from no copay to $10 and coinsurance ranging from 10% to 20%.
Diagnostic and Radiological Services See details
HumanaChoice H5216-053 (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab and outpatient X-ray services. Diagnostic procedures and tests carry no coinsurance and a copay of $0 to $105, while therapeutic radiological services require a minimum $45 copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-053 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-053 (PPO) offers cardiac rehabilitation services with no coinsurance, meaning some services are covered, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-053 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 to 20 and a $218 daily copayment for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-053 (PPO) covers acupuncture with a $50 copay, no coinsurance, and a limit of 20 treatments per year, as well as a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items and other miscellaneous services are not covered.
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