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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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $300.00 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 $8950.00 (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 $8950.00 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 pharmacy type. For example, for a standard pharmacy, you can expect to pay a $12 copay for preferred generic drugs, a $47 copay for standard generic drugs, 46% coinsurance for preferred brand drugs, and 30% coinsurance for non-preferred drugs. Once your total yearly drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-078 (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $350 copay for the first six days, and no copay for days 7-90. Outpatient services have varying copays, and emergency services have a $125 copay. The plan also covers primary care with no copay, hearing exams with a $35 copay, and vision services with no copay for eyewear. Additionally, the plan includes coverage for dental services with a $35 copay, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-6, and no copay for days 7-90, while additional days have no copay. For Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $400, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-078 (PPO) plan, with a $100 copay and prior authorization required.
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 $630 copay, and both have no coinsurance; however, 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, and Urgently Needed Services have a $55 copay; all have no coinsurance.
Primary Care See details
The HumanaChoice H5216-078 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $30 copay, and physician specialist services with a $35 copay. The plan also covers mental health specialty services and psychiatric services with a $20 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $30 copay. Additionally, the plan offers additional telehealth benefits with a copay ranging from $0 to $55, and opioid treatment program services with a $20 copay. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5216-078 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, are covered with a copay, and additional services such as Health Education, In-Home Safety Assessment, and others are not covered. The plan offers no copay for Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit.
Hearing Services See details
Hearing exams are covered with a $35 copay. Routine hearing exams are covered for one visit every year with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, but hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered with a maximum benefit of $50 every three months.
Vision Services See details
The HumanaChoice H5216-078 (PPO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare dental services with a $35 copay. Other services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services, all with no copay. Fluoride treatment, endodontics, 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, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-078 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under this plan. Durable Medical Equipment (DME) has a 10% coinsurance, while prosthetics and medical supplies have a 20% coinsurance. Diabetic supplies have a 10-20% coinsurance with no copay, and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HumanaChoice H5216-078 (PPO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $100, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $350, Therapeutic Radiological Services have a maximum copay of $40 and a coinsurance of at most 20%, and Outpatient X-Ray 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, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5216-078 (PPO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
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
The HumanaChoice H5216-078 (PPO) plan covers acupuncture with a $35 copay, and over-the-counter items with a $50 maximum benefit every three months, as well as a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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