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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 2025, 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 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced 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 $150.00 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 has a $150 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, for preferred generics at a standard pharmacy, you'll pay a $5 copay, while standard generics have a $30 copay. Preferred brand drugs have a 41% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice Florida H5216-062 (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, and outpatient services include coinsurance and copays for different services. This plan covers primary care with no copay, and also includes hearing, vision, and dental benefits. Emergency and urgent care services have copays, and other services such as ambulance, home health, and some medical equipment are also covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by HumanaChoice Florida H5216-062 (PPO). For inpatient hospital acute care, you will pay a $320 copay for days 1-7, and no copay for days 8-90, while additional days 91-999 have no copay; non-Medicare-covered stays and upgrades are not covered. For inpatient hospital psychiatric care, you will pay a $320 copay for days 1-7, and no copay for days 8-90, and additional days are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a 20% coinsurance and a copay between $0 and $300, observation services with a $320 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a 20% coinsurance and a copay between $30 and $30, and outpatient blood services with no copay. Individual and group sessions for outpatient substance abuse have a 20% coinsurance and a copay between $30 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice Florida H5216-062 (PPO). Ground ambulance services have a copay between $120 and $240, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice Florida H5216-062 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services have a $15 copay, and there is no coinsurance for any of these services.
Primary Care See details
The HumanaChoice Florida H5216-062 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25-$35 copay, and physician specialist services with a $35 copay. Mental health specialty services, psychiatric services, and other health care professional services have varying copays depending on the specific service, and physical therapy and speech-language pathology services have a $25-$35 copay. Additional telehealth benefits have a $0-$35 copay, and opioid treatment program services have a 20% coinsurance and a $30 copay.
Preventive Services See details
Preventive services include no copay for annual physical exams. Additional preventive services, kidney disease education services, and other preventive services have no copay, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Some preventive services like Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1000 every three years, while OTC hearing aids are covered with a maximum amount of $1060 every three years. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$35, routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $35 copay. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $1,500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HumanaChoice Florida H5216-062 (PPO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice Florida H5216-062 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 15% coinsurance and no copay. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered under this plan. Diagnostic procedures/tests have a coinsurance of at most 20%, while lab services have no copay and a coinsurance of at most 20%. Diagnostic radiological services have a copay of at most $275, while therapeutic radiological services have a coinsurance of at most 20% and a copay of at most $35. Outpatient X-ray services have a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Florida H5216-062 (PPO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
HumanaChoice Florida H5216-062 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Florida H5216-062 (PPO) plan, with no copay for days 1-20, and a $160 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services with the HumanaChoice Florida H5216-062 (PPO) plan includes acupuncture with no copay, and over-the-counter (OTC) items with a maximum benefit coverage amount of $60.00 every three months. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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