A non-government entity
HumanaChoice H5216-064 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-064 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-064 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-064 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Louisiana. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-064 (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 H5216-064 (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 H5216-064 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.00. 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 has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $10000.00 (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 $10000.00 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:
Sign up for HumanaChoice H5216-064 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5216-064 (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for 1-month and 3-month supplies at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a 1-month supply at standard pharmacies, and you can get a 3-month supply with no copay through preferred mail order. For Tier 3 preferred brand drugs, standard pharmacy and mail-order options require a $47 copay for a 1-month supply, while a 3-month supply through preferred mail order costs $131. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H5216-064 (PPO) plan offers robust medical coverage with no copays for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $225 daily copay for the first seven days, followed by no copay for days 8 through 90. Outpatient hospital services and emergency care feature no coinsurance, with outpatient copays ranging from no copay to $225 and emergency room visits requiring a $130 copay. This plan also includes key supplemental benefits, featuring partially covered dental care up to a $1,000 annual limit and routine vision and hearing exams with no copays. While diagnostic lab work and X-rays require no copay, durable medical equipment and dialysis services carry a 20% coinsurance. Prescription hearing aids are covered with copays ranging from $699 to $999, helping to keep out-of-pocket costs predictable for essential health services.
Inpatient Hospital See details
HumanaChoice H5216-064 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $225 daily copay for days 1 through 7 and no copay for days 8 through 90 for both acute and psychiatric stays. Unlimited additional acute days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-064 (PPO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and blood services, and a $35 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay ranging from $0 to $225 with no coinsurance, and prior authorization is required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-064 (PPO) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HumanaChoice H5216-064 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and routine transportation services to health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-064 (PPO) covers emergency services 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 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-064 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and physical therapy require copays between $20 and $35 with no coinsurance. Additional telehealth services are covered with a $0 to $50 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice H5216-064 (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, offering memory fitness and in-home support with no copay or coinsurance, while sub-services like health education, weight management, and nutritional therapy are not covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-064 (PPO), offering Medicare-covered exams for a $35 copay and routine exams or fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with a $699 to $999 copay and no coinsurance, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-064 (PPO) offers partially covered vision services with no deductibles, no coinsurance, and copays ranging from $0 to $35 for exams and select eyewear. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay, other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-064 (PPO) provides partially covered dental services up to a $1,000 annual limit, featuring preventive care with no copay and no coinsurance, Medicare-covered dental with a $35 copay and no coinsurance, and restorative services with a $25 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-064 (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-064 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-064 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and a 10% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance, with prior authorization required for most services.
Diagnostic and Radiological Services See details
HumanaChoice H5216-064 (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays have no copay, while diagnostic procedures range from a $0 to $75 copay and therapeutic radiological services require a minimum copay of $35.
Home Health Services See details
Home health services are covered by the HumanaChoice H5216-064 (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 H5216-064 (PPO) with no coinsurance and require prior authorization. Some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and carry a $15 copay.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-064 (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Covered days 1 through 20 have no copay, days 21 through 100 require a $218 copay, and prior authorization is required with no prior three-day hospital stay needed.
Other Services See details
HumanaChoice H5216-064 (PPO) partially covers other services, offering acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year, and meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved