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Humana Value Choice H5216-132 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Choice H5216-132 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Choice H5216-132 (PPO) in 2026, please refer to our full plan details page.
Humana Value Choice H5216-132 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in ID, OR. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Choice H5216-132 (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 Value Choice H5216-132 (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 Value Choice H5216-132 (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.
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 $615.00 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 $6750.00 (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 $6750.00 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 Value Choice H5216-132 (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing as low as a $5 copay for a 1-month supply at standard pharmacies, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail-order options. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Value Choice H5216-132 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, while specialist visits require a $35 copay. For hospital stays, inpatient acute care requires a $450 daily copay for the first five days, followed by no copay for additional days, with no coinsurance. Outpatient services also feature no coinsurance, with copays ranging from no copay for ambulatory surgical centers to up to $450 for outpatient hospital services. This plan also includes valuable dental, vision, and hearing benefits to help reduce your out-of-pocket costs. Dental services are covered up to a $2,000 annual maximum with no copay for most preventive and comprehensive services, and routine hearing exams feature no copay. Additionally, vision coverage includes eye exams with a copay up to $35 and eyewear with no copay, subject to annual limit allowances.
Inpatient Hospital See details
Humana Value Choice H5216-132 (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care stays require a $450 daily copay for days 1 through 5 followed by no copay for unlimited additional days, while psychiatric stays require a $416 daily copay for days 1 through 5 and no copay for days 6 through 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Value Choice H5216-132 (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most services. You will pay no copay for ambulatory surgical center and blood services, while copays range from no copay to $450 for outpatient hospital services, no copay to $35 for substance abuse sessions, and a flat $450 copay per stay for observation services.
Partial Hospitalization See details
Humana Value Choice H5216-132 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Value Choice H5216-132 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both requiring prior authorization and featuring no coinsurance. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Value Choice H5216-132 (PPO) covers emergency services with a $115 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 $115 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-132 (PPO) covers primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist, physical, occupational, and speech therapy services require a $35 copay and no coinsurance. Podiatry is not covered, and although some chiropractic services are covered with a $15 copay and no coinsurance, routine and other chiropractic services are excluded.
Preventive Services See details
Humana Value Choice H5216-132 (PPO) covers preventive services—including annual physical exams, kidney disease education, and screenings—with no copay and no coinsurance. Additional preventive services are only partially covered, offering a memory fitness benefit with no copay, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, 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, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Value Choice H5216-132 (PPO) hearing services feature no copay or coinsurance for routine exams, fitting evaluations, and OTC hearing aids, while Medicare-covered exams require a $35 copay and no coinsurance. Covered prescription hearing aids carry a copay of $699 to $999 with no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Humana Value Choice H5216-132 (PPO) provides partially covered vision services with no deductible, no coinsurance, a $0 to $35 copay for eye exams, and no copay for eyewear, subject to annual limits of $75 for exams and $150 for eyewear. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
Dental services are partially covered by Humana Value Choice H5216-132 (PPO), which features an annual maximum benefit of $2,000 with no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental services require a $35 copay and no coinsurance, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Value Choice H5216-132 (PPO) with no copay and require prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by the Humana Value Choice H5216-132 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Value Choice H5216-132 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 14% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Value Choice H5216-132 (PPO), requiring prior authorization for all services. Diagnostic tests carry a $0 to $50 copay with no coinsurance, while lab services and outpatient X-rays have no copay. Diagnostic radiology has a copay starting at $0, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Value Choice H5216-132 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Value Choice H5216-132 (PPO) plan with no coinsurance, but in practice only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-132 (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, offering no copay for days 1 to 20 and days 56 to 100, and a $218 daily copay for days 21 to 55. Prior authorization is required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Humana Value Choice H5216-132 (PPO) provides partially covered other services, including acupuncture for a $35 copay and no coinsurance, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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