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HumanaChoice Florida H5216-062 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida H5216-062 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Florida H5216-062 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Florida H5216-062 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Treasure Coast. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Florida H5216-062 (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 Florida H5216-062 (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 Florida H5216-062 (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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $6200.00 (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 $6200.00 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 Florida H5216-062 (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay when using a standard pharmacy or preferred mail order. Tier 2 generic drugs are available with a $5 copay for a one-month supply at standard pharmacies and preferred mail order, or no copay for a three-month supply through preferred mail order. Tier 3 preferred brand drugs carry a $30 copay for a one-month supply at standard pharmacies and preferred mail order. Non-preferred Tier 4 drugs require a 47% coinsurance for both one-month and three-month supplies. Finally, Tier 5 specialty drugs incur a 25% coinsurance for a one-month supply across all standard and mail order options.
Additional Benefits
The HumanaChoice Florida H5216-062 (PPO) plan offers robust coverage with no copay or coinsurance for primary care visits, preventive services, and routine vision and hearing exams. For inpatient hospital stays, members pay a $250 daily copay for days 1 through 6, followed by no copay for days 7 through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Specialist visits and mental health services require affordable copays ranging from $25 to $35. The plan also features dental benefits with a $1,750 combined annual limit and no copay for covered preventive and comprehensive services. Home health services are covered with no copay, while durable medical equipment and dialysis services generally require a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice Florida H5216-062 (PPO) covers inpatient hospital services with no coinsurance, requiring a $250 daily copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice Florida H5216-062 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copays. Outpatient hospital services carry a copay of $0 to $300, observation services require a $250 copay per stay, and outpatient substance abuse sessions have a $30 to $35 copay.
Partial Hospitalization See details
HumanaChoice Florida H5216-062 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice Florida H5216-062 (PPO) covers ground ambulance services with a copay of $120.00 to $240.00 and air ambulance services with a 20% coinsurance, with prior authorization required for all ambulance transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Florida H5216-062 (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 have a $15 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice Florida H5216-062 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, and psychiatric services have copays ranging from $25 to $35 and no coinsurance. Telehealth benefits are covered with a $0 to $35 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Florida H5216-062 (PPO) provides preventive services with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, and diabetes self-management. However, additional preventive services are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice Florida H5216-062 (PPO) covers hearing services, offering Medicare-covered exams for a $35 copay and no coinsurance, and annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,000 maximum every three years, though inner ear, outer ear, and over the ear types are not covered. OTC hearing aids are also covered with no copay and no coinsurance for up to two devices every three years.
Vision Services See details
Vision services are partially covered by HumanaChoice Florida H5216-062 (PPO) with no coinsurance and copays ranging from $0 to $35, featuring no copay for annual routine eye exams and covered eyewear. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered under this benefit.
Dental Services See details
HumanaChoice Florida H5216-062 (PPO) partially covers dental services with a $1,750 combined annual limit for in-network and out-of-network care. Medicare-covered dental requires a $35 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Florida H5216-062 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B drugs—including chemotherapy, radiation, and insulin—require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
HumanaChoice Florida H5216-062 (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice Florida H5216-062 (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, which require a 20% coinsurance and no copayment. Diabetic therapeutic shoes and inserts are covered with a $5 copayment, and prior authorization is required for most of these benefits.
Diagnostic and Radiological Services See details
HumanaChoice Florida H5216-062 (PPO) covers diagnostic and radiological services with prior authorization, generally requiring a 20% coinsurance. While lab services, diagnostic radiology, and outpatient X-rays have no copay, diagnostic tests have a copay ranging from $0 to $200, and therapeutic radiology requires a minimum copay of $35.
Home Health Services See details
HumanaChoice Florida H5216-062 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice Florida H5216-062 (PPO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. Standard cardiac rehabilitation, intensive cardiac rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a $30 copay, while pulmonary rehabilitation services are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice Florida H5216-062 (PPO) with no coinsurance, offering no copay for days 1 through 20 and a $160 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice Florida H5216-062 (PPO) partially covers other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture is limited to 25 treatments per year with prior authorization required, and OTC items are available through reimbursement.
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