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HumanaChoice Florida H5216-072 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida H5216-072 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Florida H5216-072 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Florida H5216-072 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Central Florida. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Florida H5216-072 (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 H5216-072 (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 H5216-072 (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 $1.50. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $50.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $9600.00 (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 $9600.00 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 H5216-072 (PPO) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for a standard pharmacy, you will pay a $10 copay for preferred generic drugs, and 38% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice Florida H5216-072 (PPO) plan offers a variety of benefits, including inpatient hospital stays with a $400 copay, outpatient services with a copay and coinsurance, and emergency services with a $125 copay. The plan also covers primary care for a $5 copay, and specialist visits for a $40 copay. Additional benefits include preventive services with no copay, hearing exams with a $40 copay, and dental services with no copay for many services. The plan also covers ambulance services, home infusion, medical equipment, diagnostic and radiological services, home health, skilled nursing facility, and other services, with varying copays, coinsurance, and prior authorization requirements.
Inpatient Hospital See details
The HumanaChoice Florida H5216-072 (PPO) plan covers inpatient hospital stays, including acute and psychiatric care. For inpatient acute care, there is a $400 copay for days 1-7, and no copay for days 8-90, with no coinsurance. For inpatient psychiatric care, there is a $400 copay for days 1-5, and no copay for days 6-90, with no coinsurance. Additional days for inpatient psychiatric 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 $400, and observation services with a $400 copay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services, including individual and group sessions, have a 20% coinsurance and a copay between $40 and $40. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice Florida H5216-072 (PPO). Ground Ambulance Services have a copay of $120 - $240, while Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the HumanaChoice Florida H5216-072 (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, while Urgently Needed Services have a $15 copay.
Primary Care See details
The HumanaChoice Florida H5216-072 (PPO) plan covers primary care physician services for a $5 copay, chiropractic services for a $20 copay, and occupational therapy with a copay between $20 and $40. The plan also covers physician specialist services for a $40 copay, mental health specialty services with a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services with a copay between $20 and $40. Additionally, additional telehealth benefits are covered with a copay between $0 and $40, and opioid treatment program services are covered with a 20% coinsurance and a $40 copay.
Preventive Services See details
Preventive services include Medicare-covered zero-dollar services, annual physical exams with no copay, and additional preventive services, which include fitness benefits with no copay. Other services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
The HumanaChoice Florida H5216-072 (PPO) plan covers hearing exams with a $40 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. The plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear.
Vision Services See details
Under the HumanaChoice Florida H5216-072 (PPO) plan, eye exams have a copay of $0-$40, and eyewear has no copay. Contact lenses and eyeglasses (lenses and frames) have no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include oral exams with no copay for up to 3 visits per year, dental x-rays with no copay for up to 3, other diagnostic dental services with no copay for 1 visit every three years, prophylaxis (cleaning) with no copay for 2 visits per year, and other preventive dental services with no copay for up to 4 visits per year; however, fluoride treatment is not covered. Orthodontic services are also covered, while restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice Florida H5216-072 (PPO), including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Florida H5216-072 (PPO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 12% coinsurance and no copay, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, Diabetic Supplies with 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services with a coinsurance of at most 20% and a copay, lab services with no copay and a coinsurance of at most 20%, and all radiological services with a copay and coinsurance. Diagnostic Radiological Services has a copay of at most $325, Therapeutic Radiological Services has a coinsurance of at most 20% and a copay of at most $40, and Outpatient X-Ray Services has a $5 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Florida H5216-072 (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, but the plan does not specify any details on the copay or coinsurance for the services. However, 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Florida H5216-072 (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $160 copay for days 21-100.
Other Services See details
Other Services include acupuncture, which has no copay, and has a limit of 25 treatments per year, but other services such as over-the-counter items, meal benefits, and several others are not covered. Prior authorization is required for acupuncture.
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