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HumanaChoice H5216-083 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-083 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-083 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-083 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Arkansas and Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-083 (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 H5216-083 (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 H5216-083 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.00. 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 $1000.00 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 $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:
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Drug Coverage
HumanaChoice H5216-083 (PPO) offers an Enhanced Alternative prescription drug benefit with an annual drug deductible of $615.00. For individuals who qualify for the low-income subsidy, the Part D premium is reduced from $46.00 to $30.30. During the initial coverage phase, standard pharmacies and preferred mail orders charge a $10.00 copay for preferred generics and a $47.00 copay for standard generics. Preferred brand drugs require 50% coinsurance, while non-preferred drugs have a 25% coinsurance. Once your yearly out-of-pocket costs reach $2,100.00, you enter the catastrophic coverage phase and have no copay for covered Part D drugs.
Additional Benefits
The HumanaChoice H5216-083 (PPO) plan offers robust coverage for everyday health needs, featuring no copay or coinsurance for primary care visits, preventive services, and home health care. If you require specialist visits, you will pay a $35 copay, while inpatient hospital stays incur a $360 daily copay for the first six days followed by no copay for days seven through ninety. Emergency room visits have a $130 copay, which is waived if you are admitted, and urgent care services are available with a $50 copay. For supplemental care, this plan provides routine hearing, vision, and dental services with no copay, including up to a $1,750 annual maximum for preventive and comprehensive dental care and a $200 annual allowance for eyewear. Medical equipment like durable medical equipment and dialysis services generally require a 20% coinsurance with no copay. Additionally, members benefit from covered over-the-counter items and meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by HumanaChoice H5216-083 (PPO) with a $360 daily copay for days 1 through 6 and no copay or coinsurance for days 7 through 90. Unlimited additional acute care days are covered with no copay or coinsurance, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5216-083 (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Patients will pay a copay of $0 to $385 for outpatient hospital services, $360 per stay for observation services, and $30 to $35 for outpatient substance abuse sessions.
Partial Hospitalization See details
Partial hospitalization benefits are covered under HumanaChoice H5216-083 (PPO) with a $35 copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
HumanaChoice H5216-083 (PPO) partially covers ambulance and transportation services, offering ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-083 (PPO) with a $130 copay and no coinsurance, and the copay 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 covered with a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits are covered by HumanaChoice H5216-083 (PPO) with no copay and no coinsurance for primary care visits, while specialist visits require a $35 copay and therapy services cost $30 to $40 with no coinsurance. Podiatry services are not covered, and chiropractic services are only partially covered as routine chiropractic care is excluded from coverage.
Preventive Services See details
HumanaChoice H5216-083 (PPO) partially covers preventive services, offering covered benefits like annual physical exams, kidney disease education, and fitness benefits with no copay and no coinsurance. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access technologies, home/bathroom safety modifications, and counseling services.
Hearing Services See details
HumanaChoice H5216-083 (PPO) covers hearing services with no coinsurance, offering routine hearing exams, fitting evaluations, and OTC hearing aids with no copay. Medicare-covered exams require a $35 copay, and prescription hearing aids are partially covered with a $699 to $999 copay, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
HumanaChoice H5216-083 (PPO) partially covers vision services, offering eye exams with a $0 to $35 copay and no coinsurance, and covered eyewear with no copay and no coinsurance up to a $200 annual limit. While routine eye exams and eyeglasses (lenses and frames) are covered, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-083 (PPO), with Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics not covered. Medicare-covered dental services require a $35 copay and no coinsurance, while covered preventive and comprehensive services have no copay and no coinsurance up to a $1,750 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5216-083 (PPO), requiring prior authorization and step therapy for certain drugs. Medicare Part B insulin drugs incur a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-083 (PPO) with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-083 (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required. Durable medical equipment and prosthetic devices require a 20% coinsurance and 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 HumanaChoice H5216-083 (PPO) with prior authorization. Lab services require a 20% coinsurance and no copay, therapeutic radiology requires a 20% coinsurance and a $40 copay, and outpatient X-rays require coinsurance with no copay. Diagnostic procedures require coinsurance and up to a $100 copay, while diagnostic radiological services require no coinsurance and up to a $360 copay.
Home Health Services See details
HumanaChoice H5216-083 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HumanaChoice H5216-083 (PPO) plan with no coinsurance and copayments that vary, but while some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-083 (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-083 (PPO) partially covers other services, as dual eligible SNP highly integrated services are not covered. Covered benefits include acupuncture with a $35 copay and no coinsurance, as well as over-the-counter items and meal benefits with no copay and no coinsurance.
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