A non-government entity
HumanaChoice H5216-081 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-081 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-081 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-081 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Tulsa and Oklahoma City Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-081 (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 H5216-081 (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 H5216-081 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.00. 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 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 $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:
Sign up for HumanaChoice H5216-081 (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 HumanaChoice H5216-081 (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generics require a $10 copay for a 1-month supply at standard pharmacies and preferred mail order, though you can secure a 3-month supply with no copay when utilizing preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, while a 3-month supply costs $131 through preferred mail order or $141 at standard pharmacies. Tier 4 non-preferred drugs carry a 48% coinsurance across standard pharmacies and mail order options for both 1-month and 3-month supplies. Finally, Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H5216-081 (PPO) plan provides comprehensive medical coverage, featuring no copay or coinsurance for primary care doctor visits and a $35 copay for specialists. Emergency room services require a $130 copay, which is waived upon hospital admission within 24 hours, while urgent care visits have a $50 copay. Inpatient hospital stays require a daily copay of $360 for the first six days of acute care, with no copays or coinsurance required for any additional days. For extra wellness needs, the plan features dental coverage with a $2,500 annual maximum and no copay for covered preventive and comprehensive services. Routine vision and hearing exams are available with no copay, and the plan also covers over-the-counter hearing aids and home health services with no copay. Lastly, diagnostic lab services and annual physicals are covered with no copay or coinsurance, helping you manage your health affordably.
Inpatient Hospital See details
HumanaChoice H5216-081 (PPO) covers inpatient hospital services with no coinsurance, requiring a $360 daily copay for days 1-6 of acute stays and a $318 daily copay for days 1-6 of psychiatric stays, with no copays for subsequent days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-081 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $350, observation services have a $360 copay per stay, and outpatient substance abuse sessions carry a copay of $30 to $35.
Partial Hospitalization See details
HumanaChoice H5216-081 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-081 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are not covered by this plan, meaning transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered under HumanaChoice H5216-081 (PPO) with a $130 copay and no coinsurance, which is 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 all covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-081 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Physical, occupational, and mental health therapies require a $30 copay and no coinsurance, while podiatry is not covered, and only some chiropractic services are covered with a $15 copay and no coinsurance since routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice H5216-081 (PPO) with no copay and no coinsurance for covered options like annual physical exams, glaucoma screenings, and memory fitness. However, several supplemental benefits are not covered, including health education, in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
HumanaChoice H5216-081 (PPO) provides hearing services with no coinsurance, including a $35 copay for Medicare-covered exams, no copay for routine annual exams and fitting evaluations, and no copay for over-the-counter hearing aids. Prescription hearing aids are partially covered with copays ranging from $399.00 to $699.00 and no coinsurance, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-081 (PPO) vision services are partially covered with no deductibles, no coinsurance, and no copays for routine eye exams and covered eyewear, which are subject to annual maximum limits of $75 and $250 respectively. Other eye exam services, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-081 (PPO) with an annual maximum benefit of $2,500 for both in-network and out-of-network care. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-081 (PPO) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, incur a coinsurance ranging from no coinsurance up to 20%, while covered Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
HumanaChoice H5216-081 (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-081 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, subject to prior authorization. Covered diabetic supplies require a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-081 (PPO) with prior authorization required. Lab services have no copay and no coinsurance, diagnostic tests have a copay of $0 to $90 with no coinsurance, and diagnostic radiology copays start at $0. Outpatient X-rays feature no copay but require coinsurance, while therapeutic radiology requires a minimum $35 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-081 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HumanaChoice H5216-081 (PPO) with no coinsurance and prior authorization required, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-081 (PPO) with no coinsurance, requiring a $10 copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-081 (PPO) partially covers other services, including acupuncture with a $35 copay and no coinsurance, and over-the-counter items and chronic illness meals with no copay and no coinsurance. Highly integrated dual-eligible SNP services and other miscellaneous benefits are not covered under this plan.
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