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HumanaChoice H5216-114 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-114 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-114 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-114 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Indianapolis Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-114 (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 H5216-114 (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 H5216-114 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 $250.00 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 $9600.00 (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 $9600.00 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 H5216-114 (PPO) Medicare plan features an annual prescription drug deductible of $250. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply filled at standard pharmacies or through preferred mail order. Tier 2 generic medications require a $10 copay for a 1-month supply at standard pharmacies, but you can pay no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs have a $47 copay for a 1-month supply, which drops to $131 for a 3-month supply through preferred mail order. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply across standard pharmacies and mail order options.
Additional Benefits
The HumanaChoice H5216-114 (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $45 copay, while inpatient hospital stays carry a $440 daily copay for the first six days and no copay thereafter. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital. This plan also includes valuable supplemental benefits, featuring preventive and comprehensive dental care with no copay up to a $2,500 annual limit. Routine vision exams and select eyewear are covered with no copay up to a $500 yearly limit, and routine hearing services plus over-the-counter hearing aids also feature no copay. Additionally, members benefit from up to 60 free one-way transportation trips and covered over-the-counter items with no copay.
Inpatient Hospital See details
HumanaChoice H5216-114 (PPO) covers inpatient acute hospital stays with no coinsurance and a $440 daily copay for days 1 through 6 (no copay for days 7 and beyond), and psychiatric stays with no coinsurance and a $440 daily copay for days 1 through 5 (no copay for days 6 through 90). This benefit is partially covered, as non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-114 (PPO) covers outpatient services with no coinsurance, though prior authorization is required. Outpatient hospital services have a copay ranging from $0 to $440 (including $440 per observation stay), outpatient substance abuse sessions require a $35 copay, and ambulatory surgical center and blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-114 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HumanaChoice H5216-114 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance per trip. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice H5216-114 (PPO) emergency services are covered 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 covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-114 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Therapy services range from a $15 to $40 copay, while mental health, psychiatric, and opioid treatments require a $35 copay, all with no coinsurance. Podiatry and routine chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-114 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive services are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access technologies, home modifications, and counseling.
Hearing Services See details
Hearing services under the HumanaChoice H5216-114 (PPO) plan include routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with copays from $399 to $999 and no coinsurance—excluding inner ear, outer ear, and over-the-ear types—while over-the-counter (OTC) hearing aids are available with no copay and no coinsurance.
Vision Services See details
HumanaChoice H5216-114 (PPO) partially covers vision services, providing routine eye exams and select eyewear with no copay and no coinsurance up to a $500 annual limit. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered, and non-routine eye exams may require a copay of up to $45 with no coinsurance.
Dental Services See details
Dental services are partially covered under HumanaChoice H5216-114 (PPO), offering most preventive and comprehensive care with no copay and no coinsurance up to a $2,500 annual limit, while Medicare-covered dental requires a $45 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-114 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice H5216-114 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-114 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $0 to $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H5216-114 (PPO) covers diagnostic and radiological services, offering lab services with no copay or coinsurance and outpatient X-rays with no copay. Diagnostic procedures and tests carry a copay of $0 to $105 with no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance and a copay starting at $35.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-114 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the HumanaChoice H5216-114 (PPO) plan, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered. While the plan technically lists no coinsurance, there are no active copays or benefits available for these services.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-114 (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by HumanaChoice H5216-114 (PPO) include acupuncture for a $45 copay and no coinsurance, as well as meal benefits and over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and some sub-services, such as certain items on the CMS over-the-counter list, are not covered.
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