HumanaChoice H5216-089 (PPO)

HumanaChoice H5216-089 (PPO) is a PPO plan offered by Humana Insurance Company available for the 2026 plan year to people living in Select Counties in MT. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that HumanaChoice H5216-089 (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 H5216-089 (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.

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:

Drug Coverage

The HumanaChoice H5216-089 (PPO) Medicare prescription drug plan features an annual drug deductible of $350. Tier 1 preferred generic drugs have no copay for 1-month or 3-month supplies filled at standard pharmacies or through preferred mail order. For Tier 2 generic medications, costs start at a $12 copay for a 1-month supply, though you can get a 3-month supply with no copay when using preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, with 3-month supplies costing $141 at standard pharmacies or a reduced $131 through preferred mail order. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 45% coinsurance. Tier 5 specialty drugs require 29% coinsurance for a 1-month supply across all standard and preferred pharmacy and mail order services.

Additional Benefits

The HumanaChoice H5216-089 (PPO) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copay for primary care visits, routine dental cleanings, annual physical exams, and home health services. For inpatient hospital stays, members pay a $400 daily copay for the first five days and no copay for days six through 90. Outpatient hospital services range from no copay up to a $400 copay, while emergency care carries a $130 copay that is waived if the patient is admitted within 24 hours. Specialist visits require a $40 copay, and routine vision and hearing exams are available with no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, while diagnostic lab tests and outpatient x-rays require no copay. This plan balances low-cost routine care with structured copays and coinsurance for more advanced medical services.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.