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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 2026, 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 2026.
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 $108.00. 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 H5216-063 (PPO) Medicare prescription drug 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 when using standard pharmacies or preferred mail order services. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a 1-month supply, or no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand-name drugs require a $47 copay for a 1-month supply at standard pharmacies and mail order services. For higher-tier medications, Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs incur a 25% coinsurance for a 1-month supply. This clear breakdown of copays and coinsurance helps you easily estimate your out-of-pocket prescription costs with the HumanaChoice H5216-063 (PPO) plan.
Additional Benefits
The HumanaChoice H5216-063 (PPO) plan offers comprehensive medical coverage with affordable out-of-pocket costs, including no copay for primary care physician visits and annual preventive services. Specialist visits require a $35 copay, while inpatient hospital stays carry a $190 copay per admission with no coinsurance. Emergency care is accessible with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Members also benefit from no copay on routine vision exams, preventive dental cleanings, and home health services. Medicare-covered dental services and Medicare-covered hearing exams require a $35 copay, while prescription hearing aids are covered with copayments ranging from $699 to $999. Diagnostic lab services and outpatient X-rays are also available with no copay or coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-063 (PPO) covers inpatient acute and psychiatric hospital stays with a $190 copay per admission and no coinsurance, though prior authorization is required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
HumanaChoice H5216-063 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $190 copay 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 $30 to $35 copay and no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-063 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-063 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-063 (PPO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits under HumanaChoice H5216-063 (PPO) feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $35 copay and no coinsurance. Mental health sessions have a $30 copay and therapy services carry a $40 copay, both with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-063 (PPO) preventive services are partially covered with no copay and no coinsurance for annual physicals, memory fitness, kidney disease education, and select screenings. Services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional tobacco cessation, enhanced disease management, telemonitoring, remote access technologies, home/bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services under HumanaChoice H5216-063 (PPO) are partially covered, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered for up to two devices per year with copays ranging from $699 to $999 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-063 (PPO) offers partially covered vision services with no coinsurance or deductibles, including routine eye exams and covered eyewear with no copay. Annual maximum benefits are limited to $75 for exams and $100 for eyewear, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-063 (PPO) covers Medicare-approved dental services with a $35 copay and no coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Comprehensive dental care is partially covered with no copay and no coinsurance for restorative and surgical services, though fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-063 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, insulin, and other drugs under this benefit feature no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
HumanaChoice H5216-063 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
HumanaChoice H5216-063 (PPO) covers durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and 10% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-063 (PPO) with prior authorization, featuring no copay or coinsurance for lab services and no copay for outpatient X-rays. Outpatient diagnostic tests have no coinsurance and a copay of $0 to $85, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the HumanaChoice H5216-063 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-063 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-063 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-063 (PPO) covers acupuncture with a $35 copay, no coinsurance, and a limit of 20 treatments per year, as well as chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered, and both covered benefits require prior authorization.
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