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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 2025, 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 2025.
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.
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 $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 no drug deductible. Your prescription medication coverage will start immediately.
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
The HumanaChoice H5216-083 (PPO) plan has an enhanced alternative drug benefit. The plan has no deductible. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $15 copay at both preferred and standard mail pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-083 (PPO) plan offers a wide range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays and coinsurance, and coverage for emergency and ambulance services. This plan also provides coverage for primary care, preventive services, hearing, vision, and dental services, with specific copays and maximum benefits for certain services. Additionally, the plan covers medical equipment, diagnostic and radiological services, and home health services, while also offering benefits like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $360 for days 1-6 and no copay for days 7-90. Additional days for inpatient hospital acute have no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance and a copay between $0 and $385, observation services with a $360 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a 20% coinsurance and a copay between $40 and $40, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-083 (PPO) plan, but requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice H5216-083 (PPO), with both air and ground ambulance services covered. Ground ambulance services have a $315 copay, while air ambulance services have a 20% 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 by the HumanaChoice H5216-083 (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $55 copay, and there is a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice H5216-083 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $30-$40 copay, and physician specialist services with a $45 copay. Mental health and psychiatric individual and group sessions have a $40 copay, while physical therapy and speech-language pathology services have a $30-$40 copay. Additional telehealth benefits range from no copay to a $55 copay, and opioid treatment program services have a 20% coinsurance and a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services. The plan covers Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with a maximum benefit of $75 every three months. Prescription hearing aids (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
The HumanaChoice H5216-083 (PPO) plan covers vision services, including eye exams with a copay between $0 and $45. It also covers eyewear, including contact lenses and eyeglasses (lenses and frames) with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $1,750 per year. Medicare Dental Services have a $45 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), prosthodontics (fixed), and oral and maxillofacial surgery have no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 by the HumanaChoice H5216-083 (PPO) plan, requiring prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 19% coinsurance and Prosthetics/Medical Supplies - Non-Medicare benefit, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, with Diabetic Supplies subject to a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-Ray services. Diagnostic Procedures/Tests have a copay between $0 and $100. Lab services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at most $360, while Therapeutic Radiological Services have a copay of at most $60. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-083 (PPO) plan 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 H5216-083 (PPO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-083 (PPO) plan. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
The HumanaChoice H5216-083 (PPO) plan covers acupuncture with a $45 copay, and covers over-the-counter items with a maximum benefit coverage amount of $75 every three months. This plan also covers a meal benefit with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, and other services like Early and Periodic Screening, Private Duty Nursing, and Case Management.
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