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HumanaChoice Florida H5216-074 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida H5216-074 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Florida H5216-074 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Florida H5216-074 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Lake, Marion and Sumter counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Florida H5216-074 (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 H5216-074 (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 H5216-074 (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 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 $8900.00 (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 $8900.00 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 H5216-074 (PPO) prescription drug plan features 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 medications cost a $10 copay for a 1-month supply at standard pharmacies, though you can get a 3-month supply with no copay 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 have a 48% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. Understanding these copays and coinsurance rates helps you estimate your out-of-pocket costs and maximize your Medicare benefits.
Additional Benefits
HumanaChoice Florida H5216-074 (PPO) offers robust medical coverage featuring no copay for primary care visits, preventive services, and home health care. Specialists require a $35 copay, while inpatient hospital stays cost a $280 daily copay for the first few days and no copay thereafter. Emergency room visits carry a $130 copay, which is waived if you are admitted within 24 hours. This plan also includes strong supplemental benefits, such as dental, routine vision, and routine hearing services with no copay, including up to $1,000 for hearing aids every three years. Many diagnostic services, lab tests, acupuncture, and over-the-counter items are also covered with no copay, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice Florida H5216-074 (PPO) covers inpatient hospital services with no coinsurance, requiring a $280 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
HumanaChoice Florida H5216-074 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a $0 to $295 copay, observation services have a $280 copay per stay, and outpatient substance abuse sessions carry a $30 to $35 copay, all with no coinsurance.
Partial Hospitalization See details
HumanaChoice Florida H5216-074 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice Florida H5216-074 (PPO), featuring a ground ambulance copay of $120.00 to $240.00 and a 20% coinsurance for air ambulance services, with prior authorization required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice Florida H5216-074 (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 $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice Florida H5216-074 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Other services like physical therapy, mental health, and telehealth are covered with copays ranging from $0 to $40 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Florida H5216-074 (PPO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive services are partially covered, offering a fitness benefit with no copay and no coinsurance, while excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary 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 Florida H5216-074 (PPO) covers Medicare-covered hearing exams with a $35 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription and OTC hearing aids are also covered with no copay and no coinsurance up to a $1,000 maximum limit every three years, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice Florida H5216-074 (PPO) vision services are partially covered with no deductible and no coinsurance, though prior authorization is required. Eye exams have a copay of $0 to $35 (with no copay for routine exams) and covered eyewear has no copay, but other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Florida H5216-074 (PPO) partially covers dental services with a $1,000 annual maximum, offering most preventive and comprehensive services with no copay and no coinsurance. Medicare-covered dental has a $35 copay and no coinsurance, and removable prosthodontics require a 30% coinsurance and no copay; however, fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Florida H5216-074 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice Florida H5216-074 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
HumanaChoice Florida H5216-074 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies also carry a 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $5 copay, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice Florida H5216-074 (PPO) under prior authorization, generally requiring a 20% coinsurance. Outpatient X-rays and lab services feature no copay, while diagnostic procedures and tests range from no copay to a $200 copay, and therapeutic radiological services have a minimum copay of $35.
Home Health Services See details
HumanaChoice Florida H5216-074 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HumanaChoice Florida H5216-074 (PPO) with no coinsurance and require prior authorization, though only some services are covered in practice. Specifically, standard cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Florida H5216-074 (PPO) partially covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $160 daily copay for days 21 to 100. Prior authorization is required and prior hospital stays of less than three days are allowed, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Florida H5216-074 (PPO) partially covers other services, providing acupuncture for up to 25 treatments per year and over-the-counter items with no copay and no coinsurance. Meal benefits are not covered under this plan.
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