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HumanaChoice H5216-073 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-073 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-073 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-073 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Atlanta Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-073 (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 H5216-073 (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 H5216-073 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.00. 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 has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $13900.00 (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 $13900.00 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 H5216-073 (PPO) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies or through preferred mail order, while standard mail order costs $10 for a one-month supply. Tier 2 generic drugs cost $5 for a one-month supply at standard pharmacies and preferred mail order, with no copay for a three-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply across standard pharmacies and mail order options, with a slightly reduced $131 copay for a three-month preferred mail order. Tier 4 non-preferred drugs carry a 36% coinsurance across all pharmacy and mail order types for both one-month and three-month supplies. Specialty drugs in Tier 5 require a 25% coinsurance for a one-month supply regardless of whether you use standard pharmacies, preferred mail order, or standard mail order.
Additional Benefits
The HumanaChoice H5216-073 (PPO) plan offers robust medical coverage with no copays for primary care visits, annual physicals, routine hearing exams, and home health services. For specialist visits, patients pay a $45 copay, while inpatient hospital stays require a $375 daily copay for the first several days before dropping to no copay. Emergency room visits carry a $115 copay, and urgent care services are available for a $40 copay, both with no coinsurance. Routine dental and vision care are covered with no copay, though Medicare-covered dental visits require a $45 copay. Most diagnostic lab work and outpatient X-rays also have no copay, while durable medical equipment and dialysis services generally require a 20% coinsurance. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice H5216-073 (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required for both acute and psychiatric stays. For acute stays, there is a $375 daily copay for days 1 through 7 and no copay for days 8 and beyond, while psychiatric stays require a $375 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
HumanaChoice H5216-073 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $35 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay of $0 to $450, while observation services have a $375 copay per stay, both with no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-073 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under HumanaChoice H5216-073 (PPO), offering ground and air ambulance services for a $335 copay and no coinsurance, subject to prior authorization. For transportation, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-073 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-073 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $45 copay and no coinsurance. Physical and occupational therapy require a $25 copay and no coinsurance, mental health services have a $35 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice H5216-073 (PPO) with no copays and no coinsurance for annual physicals, kidney disease education, and select screenings. Additional preventive services are partially covered, offering a memory fitness benefit but excluding health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-073 (PPO) partially covers hearing services with no coinsurance, offering routine hearing exams and fitting evaluations with no copay, and Medicare-covered exams for a $45 copay. Prescription hearing aids are covered up to two per year with a copay ranging from $699 to $999, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-073 (PPO) provides partially covered vision services with no deductible, no coinsurance, and copays ranging from no copay to $45. Annual benefits include one routine eye exam (up to $75) and one pair of eyeglasses or contact lenses (up to $100) with no copay, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-073 (PPO) features partially covered dental services with a $45 copay and no coinsurance for Medicare-covered dental care, and no copay and no coinsurance for other covered preventive and comprehensive services. Specific sub-services that are not covered under this plan include fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
HumanaChoice H5216-073 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while covered Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-073 (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-073 (PPO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Covered diabetic supplies have a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-073 (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services have no coinsurance, featuring no copay for lab services and a $0 to $120 copay for diagnostic procedures. Radiological services include outpatient X-rays with no copay, diagnostic radiology with a $0 minimum copay, and therapeutic radiology with a minimum $45 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-073 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the HumanaChoice H5216-073 (PPO) plan require prior authorization and feature no coinsurance, though some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-073 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-073 (PPO) partially covers other services, offering acupuncture with a $45 copay and no coinsurance for up to 20 treatments per year, subject to prior authorization. Over-the-counter (OTC) items, meal benefits, and dual-eligible SNP services are not covered under this plan.
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