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Humana Full Access H5216-124 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-124 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5216-124 (PPO) in 2026, please refer to our full plan details page.
Humana Full Access H5216-124 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Full Access H5216-124 (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 Humana Full Access H5216-124 (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 Humana Full Access H5216-124 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $118.00. 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 Humana Full Access H5216-124 (PPO) prescription drug plan features an annual drug deductible of $300. Tier 1 preferred generic drugs offer excellent savings with no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $10 for a 1-month supply at standard pharmacies, but you can enjoy no copay for a 3-month supply when ordering through preferred mail delivery. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply across standard pharmacies and mail order options, with a reduced 3-month copay of $131 through preferred mail order. Tier 4 non-preferred drugs require a 50% coinsurance for both 1-month and 3-month supplies across all pharmacy types. Tier 5 specialty drugs carry a 29% coinsurance for a 1-month supply at standard pharmacies and through mail order.
Additional Benefits
The Humana Full Access H5216-124 (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits and preventive services. Specialist visits require a $45 copay, while inpatient hospital stays have a $480 copay per admission with no coinsurance. Emergency room visits are covered with a $130 copay, which is waived if you are admitted within 24 hours. Supplemental benefits include up to $2,000 in dental coverage annually with no copay for preventive care, alongside routine vision exams and eyewear at no copay. Hearing care is also covered with no copay for routine exams and a $699 to $999 copay for prescription hearing aids. Finally, home health services require no copay or coinsurance, while durable medical equipment is covered with an 18% coinsurance and no copay.
Inpatient Hospital See details
Humana Full Access H5216-124 (PPO) covers inpatient acute and psychiatric hospital stays with a $480 copay per admission and no coinsurance, subject to prior authorization. This benefit is partially covered because hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Full Access H5216-124 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from $0 to $480, including a $480 copay per stay for observation services, while outpatient substance abuse individual and group sessions require a $35 copay.
Partial Hospitalization See details
Humana Full Access H5216-124 (PPO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Humana Full Access H5216-124 (PPO) with a $335 copay and no coinsurance for ground and air transport, requiring prior authorization. While transportation benefits are listed as covered, only some services are covered in practice as transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Humana Full Access H5216-124 (PPO) covers emergency services 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
Humana Full Access H5216-124 (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Other covered benefits, including physical therapy, mental health, and telehealth, feature copays ranging from $0 to $50 and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Humana Full Access H5216-124 (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive services are only partially covered; while a memory fitness benefit is included with no copay and no coinsurance, services such as health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Humana Full Access H5216-124 (PPO) hearing services are partially covered, offering Medicare-covered exams for a $45 copay and no coinsurance, plus routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with a $699 to $999 copay and no coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Humana Full Access H5216-124 (PPO) partially covers vision services with no deductible, no coinsurance, and no copay for one routine eye exam and one pair of eyeglasses or contact lenses per year. Other eye exam services, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Full Access H5216-124 (PPO) partially covers dental services up to $2,000 annually, with no copay and no coinsurance for preventive cleanings and exams. Covered restorative services require a $25 copay and no coinsurance, Medicare-covered dental has a $45 copay and no coinsurance, while fluoride, endodontics, periodontics, implants, prosthodontics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Full Access H5216-124 (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Full Access H5216-124 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Full Access H5216-124 (PPO) covers medical equipment, featuring an 18% coinsurance and no copay for durable medical equipment (DME), and a 20% coinsurance with no copay for prosthetics and medical supplies. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Full Access H5216-124 (PPO) covers diagnostic and radiological services, requiring prior authorization for all services. Diagnostic procedures and tests feature no coinsurance and copays ranging from $0 to $90, while lab services, diagnostic radiological services, and outpatient X-rays have no copays. Therapeutic radiological services require a $30 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Full Access H5216-124 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Humana Full Access H5216-124 (PPO) with no coinsurance and require prior authorization. Although some services are covered, specific programs such as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation are not covered in practice and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Full Access H5216-124 (PPO) with no coinsurance, requiring a $10 copay per day for days 1 through 20 and a $218 copay per day for days 21 through 100. Prior authorization is required, though a prior three-day inpatient hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Full Access H5216-124 (PPO) partially covers other services, offering acupuncture for a $45 copay and no coinsurance up to 20 treatments per year, alongside a chronic illness meal benefit with no copay and no coinsurance. Over-the-Counter (OTC) items are not covered under this plan.
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