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HumanaChoice Florida H5216-070 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida H5216-070 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Florida H5216-070 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Florida H5216-070 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Greater North Florida. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Florida H5216-070 (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 H5216-070 (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 H5216-070 (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 $275.00 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 $9250.00 (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 $9250.00 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 H5216-070 (PPO) plan has a $275.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you may pay a $10.00 copay for preferred generic drugs at preferred or mail-order pharmacies, or 41% coinsurance for preferred brand drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HumanaChoice Florida H5216-070 (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays and coinsurance amounts. This plan also provides coverage for primary care, preventive services, hearing, vision, and dental services, with some services available at no copay, while others have copays. Additionally, the plan covers emergency services, ambulance services, and home health services, and offers coverage for other services like diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $420 for days 1-7, and no copay for days 8-90 for acute care and days 6-90 for psychiatric care. Additional days for inpatient hospital-acute have no copay, but non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance and a copay between $0 and $360, observation services with a $420 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a 20% coinsurance and a copay between $40 and $40, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $45 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice Florida H5216-070 (PPO) plan. Ground ambulance services have a copay of $120 to $240, while air ambulance services have a 20% coinsurance; however, 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 Florida H5216-070 (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $15 copay and no coinsurance, and Worldwide Emergency Services have a $125 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice Florida H5216-070 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay (prior authorization required), occupational therapy services with a $10-$40 copay (prior authorization required), physician specialist services with a $45 copay, and mental health specialty services with a $30 copay for individual and group sessions (prior authorization required). The plan also covers other health care professional services with a $5-$45 copay (prior authorization required), psychiatric services with a $30 copay for individual and group sessions (prior authorization required), physical therapy and speech-language pathology services with a $10-$40 copay (prior authorization required), additional telehealth benefits with a $0-$45 copay, and opioid treatment program services with a 20% coinsurance and a $40 copay (prior authorization required). Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services like Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas with no copay. Other services such as Health Education, In-Home Safety Assessment, and Personal Emergency Response System (PERS) are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1,000 every three years, and OTC hearing aids are covered with no copay, up to $1,000 every three years. Prescription hearing aids are not covered for inner ear, outer ear, or over the ear.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Florida H5216-070 (PPO) covers a range of dental services, including oral exams and dental x-rays with no copay, and other diagnostic dental services and prophylaxis (cleaning) also with no copay. The plan does not cover fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, or orthodontics. The plan has a maximum benefit of $1,500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice Florida H5216-070 (PPO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Florida H5216-070 (PPO) plan and require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 16% coinsurance and no copay, as well as Prosthetic Devices and Medical Supplies with a 20% coinsurance and no copay. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered under the HumanaChoice Florida H5216-070 (PPO) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20% and Diagnostic Procedures/Tests have a maximum copay of $200.00. Diagnostic Radiological Services have a maximum copay of $360.00, Therapeutic Radiological Services have a coinsurance of at most 20% and a maximum copay of $45.00, and Outpatient X-Ray Services have a 20% coinsurance and a $5 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Florida H5216-070 (PPO) plan with no copay and no coinsurance. However, 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 any of the listed sub-services, including 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. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Florida H5216-070 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $160 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes acupuncture with no copay, but is limited to 25 treatments per year and requires prior authorization. Over-the-Counter (OTC) Items, Meal Benefit, 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.
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