A non-government entity
Humana Value Choice H5216-078 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Choice H5216-078 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Choice H5216-078 (PPO) in 2026, please refer to our full plan details page.
Humana Value Choice 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 2026.
It's important to know that Humana Value Choice 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 Humana Value Choice 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 Humana Value Choice 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 $1.00. 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 $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:
Sign up for Humana Value Choice H5216-078 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Value Choice H5216-078 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost an $8 copay for a 1-month supply at standard pharmacies and preferred mail order, with no copay required for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options, though a 3-month preferred mail order supply reduces the cost to a $94 copay. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 47% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Value Choice H5216-078 (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits and routine preventive services, while specialist visits require a $35 copay. Inpatient hospital stays require a $300 daily copay for the first five days and no copay thereafter, while outpatient hospital services range from no copay to a $300 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care is available for a $50 copay. Additional benefits include robust coverage for routine vision and hearing exams with no copays, alongside dental benefits that cover most services with no copay up to a $1,250 annual limit. Durable medical equipment and dialysis services are available with no copay but require coinsurance of 15% and 20% respectively. Home health care and laboratory services are also covered with no copay, helping to keep your out-of-pocket costs predictable.
Inpatient Hospital See details
Humana Value Choice H5216-078 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 to 5 and no copay for days 6 to 90 per stay. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Value Choice H5216-078 (PPO) outpatient services are covered with no coinsurance, though prior authorization is required for most services. There is no copay for ambulatory surgical center and blood services, while outpatient hospital services carry a copay of $0 to $300, and outpatient substance abuse sessions require a copay of $25 to $35.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Value Choice H5216-078 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Value Choice H5216-078 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a $630 copay, with no coinsurance required for either. For transportation benefits, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Value Choice H5216-078 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-078 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Therapy services have a $20 copay, mental health services have a $25 copay, and telehealth services range from a $0 to $50 copay, all with no coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Humana Value Choice H5216-078 (PPO) provides partially covered preventive services with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, memory fitness, and select screenings. Multiple supplemental benefits are not covered under this plan, such as health education, weight management programs, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by Humana Value Choice H5216-078 (PPO), offering routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $999 copay and no coinsurance—excluding inner ear, outer ear, and over-the-ear models—while over-the-counter hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Value Choice H5216-078 (PPO) vision services are partially covered, offering no copays, no coinsurance, and no deductibles for routine care. Covered benefits include one routine eye exam per year (up to a $40 limit) and one annual pair of eyeglasses or contact lenses (up to a $400 limit), while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Value Choice H5216-078 (PPO) covers Medicare-covered dental services with a $35 copay and no coinsurance, alongside partially covered preventive and comprehensive dental benefits up to a $1,250 annual limit. Most covered dental services feature no copay and no coinsurance, except for fixed and removable prosthodontics which have a 30% coinsurance and no copay, while fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Value Choice H5216-078 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Value Choice H5216-078 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Humana Value Choice H5216-078 (PPO) covers durable medical equipment with no copay and 15% coinsurance, and prosthetics and medical supplies with no copay and 15% to 20% coinsurance. Diabetic supplies are covered with no copay and 10% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Value Choice H5216-078 (PPO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have a $0 to $100 copay with no coinsurance, while therapeutic radiological services require a minimum $40 copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Value Choice H5216-078 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Value Choice H5216-078 (PPO) covers some cardiac rehabilitation services with no copay, no coinsurance, and prior authorization required, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-078 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Value Choice H5216-078 (PPO) provides partial coverage for other services, including acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year. Over-the-counter items and meal benefits for chronic illnesses are also covered with no copay and no coinsurance, while other additional services under this category are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved