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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 2025, 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 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $4.00. 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 $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 $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 has a $250 deductible for prescription drugs. In the initial coverage phase, after the deductible, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $0 copay at preferred pharmacies and a $47 copay at standard and mail-order pharmacies. Preferred brand drugs have a 33% coinsurance, and non-preferred drugs have a 30% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The HumanaChoice Florida H5216-068 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but some days are covered with no copay. Outpatient services, primary care, and preventive services often have no copay, while specialist visits and other services have copays. The plan also covers ambulance services, emergency services, and home health services, as well as offers coverage for hearing, vision, and dental services. There are copays and coinsurance amounts for services like ambulance and specialist visits. This plan also includes coverage for medical equipment, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-6, and no copay for days 7-90, and for days 91-999 you will pay no copay. Inpatient Hospital Psychiatric has a $320 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, Additional Days for Inpatient Hospital Psychiatric and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $0-$300 copay and 20% coinsurance, Observation Services with a $320 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $30 copay and 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with a $30 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a copay of $120-$240, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a copay of $140, while Urgently Needed Services have a $15 copay; there is no coinsurance for any of these services. For emergency services, the copay is waived if you are admitted to the hospital within 24 hours.
Primary Care See details
The HumanaChoice Florida H5216-068 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $35 and $45, physician specialist services with a $35 copay, and mental health specialty services with a $30 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a copay between $35 and $45, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a 20% coinsurance and a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HumanaChoice Florida H5216-068 (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 covered with no copay. Some preventive services like Health Education, In-Home Safety Assessment, and others 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 have a maximum benefit of $1,000 every three years, and OTC hearing aids have a maximum benefit of $1,050 every three years. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Florida H5216-068 (PPO) plan includes dental services with a $3,000 annual maximum benefit. Medicare Dental Services have a $35 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed, and Oral and Maxillofacial Surgery have no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implants Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HumanaChoice Florida H5216-068 (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay with 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 under the HumanaChoice Florida H5216-068 (PPO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by the HumanaChoice Florida H5216-068 (PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment, with the specifics of coinsurance and copay dependent on the service. Diabetic Supplies have 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a coinsurance of up to 20% and a copay of up to $200, Lab Services with a coinsurance of up to 20% and no copay, Diagnostic Radiological Services with a copay of up to $300, Therapeutic Radiological Services with a coinsurance of up to 20% and a copay of $30 to $35, and Outpatient X-Ray Services with a coinsurance of up to 20% and no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Florida H5216-068 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice Florida H5216-068 (PPO) plan, but specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Florida H5216-068 (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $160 copay for days 21-100.
Other Services See details
Other Services includes acupuncture, which has no copay, and over-the-counter items, which are covered up to $50 every three months. Other services such as meals, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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