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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 $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $350.00 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, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for a standard generic drug, you'll pay a $47 copay. For preferred brand drugs, you'll pay 46% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-078 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and home health services have no copay. The plan covers primary care, preventive services, hearing, vision, and dental services with copays, and provides coverage for ambulance, emergency, and skilled nursing facility services, each with its own cost structure.
Inpatient Hospital See details
Inpatient Hospital care, including acute and psychiatric services, is covered under the HumanaChoice H5216-078 (PPO) plan. For days 1-6, there is a $370 copay, and days 7-90 have no copay; additional days for acute inpatient hospital 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 $370 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-078 (PPO) plan. This benefit has a $100 copay and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-078 (PPO) plan. Ground ambulance services have a $315 copay, and air ambulance services have a $630 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 under the HumanaChoice H5216-078 (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-078 (PPO) plan offers primary care services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay. Physician specialist services have a $50 copay, and physical therapy and speech-language pathology services have a $40 copay. Mental health and psychiatric services, as well as opioid treatment program services, also have a copay of $40. Additional telehealth benefits range from no copay to a $55 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. The plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services. Fitness Benefit is covered, but other additional services may have a copay.
Hearing Services See details
Hearing exams are covered under the HumanaChoice H5216-078 (PPO) plan with a $50 copay, and routine hearing exams are covered with no copay for one visit every year. Prescription hearing aids (all types) are covered with a copay between $599 and $899 for two visits every year, while OTC hearing aids are covered up to $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 $50, and eyewear with no copay. 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 $50 copay, and other dental services including 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 and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 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 benefits include Durable Medical Equipment (DME) with 5% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with a coinsurance and copay, and Diabetic Supplies with 10-20% coinsurance and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $100, and lab services with no copay. Radiological services include coverage for diagnostic and therapeutic radiological services, with a maximum copay of $370 and $40 respectively, and a minimum coinsurance of 20% for therapeutic radiological services, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-078 (PPO) 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, 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 by the HumanaChoice H5216-078 (PPO) plan. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214.
Other Services See details
The HumanaChoice H5216-078 (PPO) plan covers acupuncture with a $50 copay, up to 20 treatments per year, and requires prior authorization. This plan also covers over-the-counter (OTC) items, including nicotine replacement therapy and Naloxone, with a maximum benefit of $50 every three months. Additionally, this plan covers a meal benefit with no copay, but does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services.
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