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Humana Value Choice H5216-070 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Choice H5216-070 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Choice H5216-070 (PPO) in 2026, please refer to our full plan details page.
Humana Value Choice 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 2026.
It's important to know that Humana Value Choice 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 Humana Value Choice 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 Humana Value Choice 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 $1.00. 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 $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 $8750.00 (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 $8750.00 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 Humana Value Choice H5216-070 (PPO) prescription drug plan has 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 at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also very affordable, offering a $5 copay for a 1-month supply at standard pharmacies and no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail order options. For higher-tier medications, Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply. Knowing these copayment and coinsurance rates can help you determine if this PPO plan fits your budget and medication needs.
Additional Benefits
The Humana Value Choice H5216-070 (PPO) plan offers comprehensive everyday health coverage, featuring no copay for primary care doctor visits, preventive services, and routine eye or hearing exams. Members can take advantage of dental coverage up to a $1,750 yearly limit with no copay for cleanings and exams, alongside a $100 annual eyewear allowance. Specialist visits are also highly accessible, requiring a flat $35 copay with no coinsurance. For major medical care, inpatient hospital stays require a $420 daily copay for days one through seven, after which there is no copay. Emergency room visits carry a $130 copay that is waived if you are admitted, while home health services and outpatient surgery center visits require no copay. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days, helping you manage recovery costs effectively.
Inpatient Hospital See details
Humana Value Choice H5216-070 (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you pay a $420 daily copay for days 1 through 7 and no copay for days 8 and beyond, while psychiatric stays require a $420 daily copay for days 1 through 5 and no copay for days 6 through 90. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Value Choice H5216-070 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services carry a copay of $0 to $295 (or $420 per stay for observation), while outpatient substance abuse sessions require a copay of $30 to $35.
Partial Hospitalization See details
Humana Value Choice H5216-070 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Value Choice H5216-070 (PPO) partially covers ambulance and transportation services, offering ground ambulance services for a $120.00 to $240.00 copay with no coinsurance and air ambulance services for a 20% coinsurance with no copay, both requiring prior authorization. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Humana Value Choice H5216-070 (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 $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-070 (PPO) primary care benefits include primary care physician visits with no copay and no coinsurance, and specialist visits for a $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $40 copay with no coinsurance, while podiatry and chiropractic services are not covered. Prior authorization is required for most specialist, therapy, and mental health services.
Preventive Services See details
Humana Value Choice H5216-070 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are only partially covered, as the plan excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, caregiver support, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Humana Value Choice H5216-070 (PPO) covers routine hearing exams, fittings, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered hearing exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,000 maximum limit every three years, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Value Choice H5216-070 (PPO) with no coinsurance and a $0 to $35 copay for eye exams, which includes one routine exam per year with no copay. Eyewear is covered with no copay and no coinsurance up to a $100 annual limit for one pair of contact lenses or eyeglasses (lenses and frames), while other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by Humana Value Choice H5216-070 (PPO) up to a $1,750 yearly maximum, offering Medicare-covered dental with a $35 copay and no coinsurance, and other covered services with no copay and no coinsurance. This partially covered benefit includes exams, cleanings, x-rays, restorative care, and periodontics, while fluoride, endodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Value Choice H5216-070 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Humana Value Choice H5216-070 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Value Choice H5216-070 (PPO) covers durable medical equipment with a 15% coinsurance and no copay, and prosthetic devices, medical supplies, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are covered with a $5 copay, and prior authorization is required for most of these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Humana Value Choice H5216-070 (PPO) plan, with diagnostic procedures requiring a $0 to $200 copay and 20% coinsurance, and therapeutic radiological services carrying a copay starting at $45 and 20% coinsurance. Lab and outpatient X-ray services feature no copay but require coinsurance, while diagnostic radiological services are covered with no copay and no coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Value Choice H5216-070 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Humana Value Choice H5216-070 (PPO) cardiac rehabilitation services require prior authorization and have no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. These non-covered services require copays of $30.00 for cardiac and intensive cardiac, $15.00 for pulmonary, and $25.00 for SET for PAD therapies.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-070 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by 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
Other services are partially covered by the Humana Value Choice H5216-070 (PPO) plan, which offers acupuncture and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
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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.
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