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HumanaChoice Florida H5216-068 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida H5216-068 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Florida H5216-068 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Florida H5216-068 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Broward, Miami-Dade and Palm Beach Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Florida H5216-068 (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 H5216-068 (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 H5216-068 (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 $6100.00 (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 $6100.00 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 H5216-068 PPO plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order delivery for these generic tiers ranges from a $10 to $20 copay for a one-month supply. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with standard mail order and pharmacy options costing $141 for a three-month supply. Higher-tier medications incur coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 41% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. These structured drug tier costs help you estimate your out-of-pocket prescription expenses with this Humana Medicare plan.
Additional Benefits
The HumanaChoice Florida H5216-068 (PPO) plan offers affordable medical coverage with no copay for primary care doctor visits and a $35 copay for specialists. Covered preventive care, home health services, and routine hearing and vision exams also feature no copays or coinsurance. For inpatient hospital stays, members pay a $300 daily copay for days 1 through 6 and no copay for days 7 through 90, with no coinsurance required. Dental benefits cover preventive and comprehensive services with no copay up to a $3,000 annual limit, while hearing aid benefits offer up to a $1,000 allowance every three years. Essential medical equipment and outpatient dialysis services are covered with no copay and coinsurance rates of 10% and 20% respectively. Emergency care is accessible worldwide with a $150 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
HumanaChoice Florida H5216-068 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 through 6 and no copay for days 7 through 90 for acute and psychiatric stays. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice Florida H5216-068 (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $300, observation services carry a $300 copay per stay, and outpatient substance abuse sessions have a copay of $30 to $35.
Partial Hospitalization See details
HumanaChoice Florida H5216-068 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice Florida H5216-068 (PPO) covers ambulance services with a $120 to $240 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required. For transportation, some services are covered, but transportation to plan-approved locations and any health-related locations is not covered.
Emergency Services See details
HumanaChoice Florida H5216-068 (PPO) covers emergency services with a $150 copay—which is waived if admitted to the hospital within 24 hours—and no coinsurance, while urgently needed services require a $15 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance.
Primary Care See details
HumanaChoice Florida H5216-068 (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Other covered benefits, such as physical, occupational, mental health, and telehealth services, feature copays ranging from $0 to $45 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Florida H5216-068 (PPO) preventive services are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs following a welcome visit. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice Florida H5216-068 (PPO) covers hearing services, featuring routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 allowance every three years—excluding inner ear, outer ear, and over-the-ear types—while up to two OTC hearing aids are covered every three years with no copay or coinsurance.
Vision Services See details
Vision Services are partially covered by HumanaChoice Florida H5216-068 (PPO), offering eye exams with a $0 to $35 copay and eyewear with no copay, both featuring no coinsurance and no deductibles. While routine eye exams, contact lenses, and eyeglasses are covered up to annual plan limits, other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Florida H5216-068 (PPO) covers dental services up to a $3,000 annual maximum, with a $35 copay and no coinsurance for Medicare-covered dental. Preventive and comprehensive services are partially covered with no copay and no coinsurance, though prosthodontics require a 30% coinsurance (no copay), and fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Florida H5216-068 (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice Florida H5216-068 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HumanaChoice Florida H5216-068 (PPO), featuring a 10% coinsurance and no copay for durable medical equipment (DME) and prosthetic devices. Medical and diabetic supplies carry a 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a $5 copay.
Diagnostic and Radiological Services See details
HumanaChoice Florida H5216-068 (PPO) covers diagnostic and radiological services, which require prior authorization and carry a minimum 20% coinsurance. Members will pay no copay for lab services, diagnostic radiology, and outpatient X-rays, while diagnostic procedures range from no copay up to $200, and therapeutic radiology requires a minimum $30 copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice Florida H5216-068 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by HumanaChoice Florida H5216-068 (PPO) with no coinsurance and required prior authorization. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and carry copays between $20 and $30.
Skilled Nursing Facility (SNF) See details
HumanaChoice Florida H5216-068 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $160 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Florida H5216-068 (PPO) partially covers other services, offering acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while Dual Eligible SNPs and other miscellaneous services are not covered.
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