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HumanaChoice H5216-106 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-106 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-106 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-106 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Northeast Ohio Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-106 (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 H5216-106 (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 H5216-106 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $1.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 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 $10100.00 (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 $10100.00 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 H5216-106 (PPO) Medicare plan features a $300 drug deductible and offers multiple ways to save on prescription costs. For Tier 1 preferred generics, there is no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generics also feature no copay for a three-month supply through preferred mail order, or a $15 copay for a one-month supply at standard pharmacies. Tier 3 preferred brand drugs cost a $47 copay for a one-month supply, with three-month mail-order options starting at a $131 copay. For higher-tier medications, you will pay a 50% coinsurance for Tier 4 non-preferred drugs and a 29% coinsurance for Tier 5 specialty drugs. These cost-sharing tiers allow you to select the most economical pharmacy and mail-order options for your prescription needs.
Additional Benefits
The HumanaChoice H5216-106 (PPO) plan offers comprehensive medical coverage with no copay for primary care doctor visits and preventive services, while specialist visits require a $50 copay. For hospital stays, inpatient services feature a daily copay of $440 for the first several days before dropping to no copay, and outpatient services range from no copay to a $440 copay depending on the service. Emergency care is accessible with a $125 copay, which is waived if you are admitted, and urgent care carries a $50 copay. Routine dental, hearing, and vision exams are covered with no copay, though there are annual coverage limits of $1,500 for dental and $100 for eyewear. Durable medical equipment and dialysis services require no copay but carry a 20% coinsurance. Home health services are fully covered with no copay or coinsurance, ensuring affordable support.
Inpatient Hospital See details
HumanaChoice H5216-106 (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute inpatient stays require a $440 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays carry a $440 daily copay for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-106 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $440, outpatient observation services require a $440 copay per stay, and outpatient substance abuse sessions require a $35 copay, with prior authorization required for most of these services.
Partial Hospitalization See details
HumanaChoice H5216-106 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-106 (PPO) covers ground and air ambulance services with a $315 copay per service and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
HumanaChoice H5216-106 (PPO) covers emergency services with a $125 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 covered with a $125 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-106 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Most other primary care services, including therapy and mental health, carry copays ranging from $10 to $50 and no coinsurance, though chiropractic services are only partially covered as routine and other chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-106 (PPO) preventive services, including annual physicals, kidney disease education, and glaucoma screenings, are covered with no copay and no coinsurance. Additional preventive benefits are only partially covered; the memory fitness benefit is covered with no copay and no coinsurance, but 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, chemotherapy-related wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, extra tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, or counseling services.
Hearing Services See details
HumanaChoice H5216-106 (PPO) covers Medicare-covered hearing exams for a $50 copay, while routine exams and fitting evaluations have no copay, all with no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices annually, but OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
HumanaChoice H5216-106 (PPO) provides partially covered vision services with no deductible, no coinsurance, and a $0 to $50 copay for eye exams, which includes one routine exam per year with no copay. Covered eyewear, including one pair of contact lenses or eyeglasses, has no copay and no coinsurance up to a $100 annual limit, while other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-106 (PPO) up to a combined annual maximum of $1,500, requiring a $50 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services. Fluoride treatments, implants, orthodontics, maxillofacial prosthetics, and removable prosthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-106 (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy and other Part B drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-106 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-106 (PPO), featuring a 20% coinsurance and no copay for durable medical equipment (DME), prosthetics, and medical supplies. Covered diabetic supplies carry a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts are also covered with no copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-106 (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic procedures feature no coinsurance and a copay of $0 to $105, diagnostic radiological services start at a $0 copay, and therapeutic radiological services require a minimum $40 copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-106 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-106 (PPO) with no coinsurance and a $10 copay, subject to prior authorization. Although some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-106 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 copayment for days 1 to 20 and a $214 copayment for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-106 (PPO) covers select other services, including acupuncture with a $50 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Prior authorization is required for these covered services, while over-the-counter (OTC) items are not covered.
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