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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.
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 $305.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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:
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Drug Coverage
The Humana Value Choice H5216-078 (PPO) prescription drug plan has an annual drug deductible of $615. You can save on Tier 1 preferred generic drugs with no copay for one-month and three-month supplies at standard pharmacies or through preferred mail order. Tier 2 generic medications cost an $8 copay for a one-month supply at standard pharmacies, or no copay for a three-month supply via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply, which can be extended to a three-month supply for $94 through preferred mail order. Tier 4 non-preferred drugs require a 47% coinsurance, and Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply across all pharmacy and mail order options.
Additional Benefits
The Humana Value Choice H5216-078 (PPO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $50 copay, while inpatient hospital stays carry a $325 daily copay for the first six days and no copay for subsequent days. Emergency room visits have a $115 copay, which is waived if you are admitted, and urgently needed services require a $50 copay. Routine dental, vision, and hearing exams are covered with no copay and no coinsurance, though prescription hearing aids require copays ranging from $599 to $899. Durable medical equipment and diabetic supplies are covered with a 10% to 20% coinsurance and no copay. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Humana Value Choice H5216-078 (PPO) covers inpatient hospital care with no coinsurance, requiring a $325 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered, as 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, including no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services carry a copay of $0 to $325, while outpatient substance abuse sessions require a $25 to $35 copay.
Partial Hospitalization See details
Humana Value Choice H5216-078 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Value Choice H5216-078 (PPO) covers Medicare-covered ground ambulance services with a $335 copay and air ambulance services with a $630 copay, with no coinsurance required for either. Transportation services are not covered under this plan, meaning trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Humana Value Choice H5216-078 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are available with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-078 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits have a $50 copay and no coinsurance. Other benefits like physical therapy, occupational therapy, and mental health services require copays ranging from $25 to $30 with no coinsurance, and telehealth services feature copays from no copay to $50 with no coinsurance. Chiropractic services are only partially covered, with routine and other chiropractic care excluded from coverage.
Preventive Services See details
Preventive services are partially covered by Humana Value Choice H5216-078 (PPO) with no copay and no coinsurance for covered care such as annual physicals, smoking cessation, memory fitness, and diabetes training. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, weight management, alternative therapies, and home-based support.
Hearing Services See details
Humana Value Choice H5216-078 (PPO) covers hearing services with no deductible, offering routine hearing exams and fitting evaluations for no copay and no coinsurance, while Medicare-covered exams require a $50 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $599 to $899, though inner ear, outer ear, and over the ear prescription models are not covered. Over-the-counter hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Humana Value Choice H5216-078 (PPO) provides partially covered vision services with no deductibles, no coinsurance, and no copays for covered services, which include one routine eye exam (up to $40 yearly) and select eyewear (up to $300 yearly). Covered eyewear is limited to one pair of contact lenses or eyeglasses (lenses and frames) per year, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Value Choice H5216-078 (PPO) offers partially covered dental services with no copay and no coinsurance for preventive and most comprehensive care, while Medicare-covered dental services require a $50 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Value Choice H5216-078 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B drugs for these services, including chemotherapy and insulin, are covered with coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Humana Value Choice H5216-078 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by Humana Value Choice H5216-078 (PPO), featuring durable medical equipment and medical supplies at a 15% coinsurance with no copay. Prosthetic devices require a 20% coinsurance with no copay, while diabetic supplies have a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Value Choice H5216-078 (PPO), with prior authorization required for all services. Lab and diagnostic radiological services feature no copay and no coinsurance, while diagnostic tests carry a $0 to $100 copay with no coinsurance. Therapeutic radiological services require a $40 copay and 20% coinsurance, and outpatient X-rays have no copay but require coinsurance.
Home Health Services See details
Humana Value Choice H5216-078 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Value Choice H5216-078 (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization. However, only some services are covered in practice, and standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation 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, followed by a $218 copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Humana Value Choice H5216-078 (PPO) covers acupuncture with a $50 copay and no coinsurance for up to 20 treatments yearly, alongside over-the-counter items and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and some miscellaneous other services are not covered.
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