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HumanaChoice H5216-063 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-063 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-063 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-063 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Minnesota. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-063 (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 H5216-063 (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 H5216-063 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $102.00. 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 $250.00 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 H5216-063 (PPO) plan has a $250 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy, while standard generic drugs have a $47 copay. Once your total yearly drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-063 (PPO) plan offers a range of benefits, including inpatient hospital stays with a $190 copay, outpatient services with varying copays, and emergency services with copays from $65-$140. Primary care visits are covered with no copay, and preventive services, such as an annual physical exam, are also covered with no copay. Vision and hearing services are included, with eye exams, eyewear, and hearing exams covered with no copay, and hearing aids partially covered. Dental services are covered, with oral exams, dental x-rays, and other diagnostic dental services covered with no copay. There are also services like home health, and skilled nursing facilities covered.
Inpatient Hospital See details
Inpatient Hospital coverage, including Acute and Psychiatric, requires prior authorization and has a copay of $190 per admission or stay, with no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient services with the HumanaChoice H5216-063 (PPO) plan include coverage for all outpatient hospital services, with a copay between $0 and $300, and observation services with a $190 copay per stay. Ambulatory Surgical Center (ASC) services and outpatient blood services have no copay, while outpatient substance abuse services have copays between $25 and $85 for both individual and group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice H5216-063 (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-063 (PPO) plan, with a $315 copay for ground ambulance services and 20% coinsurance for air ambulance services. 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 H5216-063 (PPO) plan. Emergency Services has a $140 copay, Urgently Needed Services has a $65 copay, and Worldwide Emergency Services has a $140 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice H5216-063 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $35 copay. Mental health specialty services have a $35 copay, while physical therapy and speech-language pathology services have a $40 copay. Additionally, the plan covers telehealth benefits with a copay between $0 and $65, and opioid treatment program services with a copay between $25 and $85. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5216-063 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay. However, health education, in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams have no copay. Fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The HumanaChoice H5216-063 (PPO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay. This plan offers coverage for routine eye exams with no copay, contact lenses with no copay, and eyeglasses (lenses and frames) with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-063 (PPO) plan covers Medicare Dental Services with a $35 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. However, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-063 (PPO) plan, with prior authorization required. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment are covered. Durable Medical Equipment has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic procedures/tests have a copay of $0-$85, while lab services have no copay. Radiological services are covered, with diagnostic radiological services having a copay of up to $350, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-063 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay for some services, but the specific copay amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5216-063 (PPO) plan. For days 1-20, the copay is $20, and for days 21-100, the copay is $203; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, which has a $35 copay, and a meal benefit with no copay, while over-the-counter items, 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. Acupuncture is limited to 20 treatments per year and requires prior authorization.
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