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HumanaChoice H5216-078 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-078 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-078 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-078 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-078 (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 H5216-078 (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 H5216-078 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.00. 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 $800.00 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 $10000.00 (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 $10000.00 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 H5216-078 (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 the pharmacy you use. For generic drugs, you will pay a copay of $12-20, while brand-name drugs have a 46% coinsurance. Non-preferred drugs have a 30% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-078 (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find no copays for many preventive services, routine eye exams, and dental cleanings, but there are copays for primary care visits, specialist services, and hearing exams. This plan also includes coverage for emergency services, ambulance services, and home health services, all with specific copays or coinsurance. Additional benefits include hearing, vision, and dental coverage, as well as medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For days 1-5 of inpatient hospital stays, there is a $410 copay, and for days 6-90, there is no copay; additional days for acute inpatient hospital stays have no copay.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with a copay between $0 and $500, and observation services with a $410 copay. Ambulatory Surgical Center (ASC) services have no copay, and outpatient blood services also have no copay. Outpatient substance abuse services are covered with a $60 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-078 (PPO) plan, and requires prior authorization. The copay for this benefit is $70.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice H5216-078 (PPO). Ground ambulance services have a $315 copay, while air ambulance services have a $1250 copay; both have no coinsurance. 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all services have no coinsurance.
Primary Care See details
The HumanaChoice H5216-078 (PPO) plan covers Primary Care Physician Services with a $10 copay, Chiropractic Services with a $15 copay, and Physician Specialist Services with a $70 copay. Occupational Therapy Services have a $45 copay, while Physical Therapy and Speech-Language Pathology Services have a $45 copay. Mental Health and Psychiatric services have a $60 copay for both individual and group sessions. Podiatry Services have a $55-$70 copay, and Other Health Care Professional services have a $10-$70 copay. Additional Telehealth Benefits have a $0-$70 copay. Opioid Treatment Program Services have a $60 copay.
Preventive Services See details
The HumanaChoice H5216-078 (PPO) plan covers a variety of preventive services. Annual physical exams have no copay. Additional preventive services, as well as kidney disease education services, and other preventive services have a copay. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay. Other services like health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with a $70 copay for hearing exams and no copay for routine exams and fitting/evaluation. Prescription hearing aids are covered, with a copay between $699 and $999 for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5216-078 (PPO) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $70, while routine eye exams have no copay. Eyewear has no copay, and a combined maximum of $100 per year applies to both in-network and out-of-network services. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-078 (PPO) plan covers Medicare Dental Services with a $70 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services with no copay. Fluoride Treatment, 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with an 18% coinsurance and prior authorization, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no 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, and outpatient X-ray services, are covered, with copays ranging from $0 to $410 and coinsurance of up to 20% for therapeutic radiological services. Lab services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-078 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H5216-078 (PPO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5216-078 (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay.
Other Services See details
Other Services include acupuncture and meal benefits, but do not include over-the-counter items, 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. Acupuncture has a $70 copay, and the meal benefit has no copay.
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