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Humana Full Access H5216-132 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access 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 Full Access H5216-132 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access 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 2025.
It's important to know that Humana Full Access 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 Full Access 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 Full Access 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. Additionally, this plan comes with a Part B Premium reduction of $2.00. 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 $150.00 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 $5900.00 (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 $5900.00 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 H5216-132 (PPO) plan has a $150 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For generic drugs at a standard pharmacy, you will pay a $10 copay for preferred generics and a $47 copay for standard generics. For brand name and non-preferred drugs, you will pay coinsurance, which is a percentage of the drug's cost.
Additional Benefits
The Humana Full Access H5216-132 (PPO) plan offers a range of benefits with varying costs. You'll find no copays for services like primary care visits, preventive care, and many dental services. However, be aware of copays for services such as inpatient hospital stays, outpatient services, specialist visits, and ambulance services, with costs varying depending on the service. This plan includes coverage for hearing, vision, and dental services. Hearing services include no copay for routine exams and hearing aid fittings, and copays for hearing aids. Vision services include eye exams with a copay, and dental services have no copay for many services with a $2,000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a copay of $325 for days 1-7 and no copay for days 8-90, and Additional Days for Inpatient Hospital-Acute with no copay for days 91-999. Inpatient Hospital Psychiatric benefits are covered, with a copay of $310 for days 1-7 and no copay for days 8-90. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $325, observation services have a $325 copay, and ambulatory surgical center services and outpatient blood services have no copay; outpatient substance abuse services have a copay between $40 and $50 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan. You will have an $85 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Full Access H5216-132 (PPO) plan. Ground ambulance services have a copay of $315, and air ambulance services have a copay of $1250, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Full Access H5216-132 (PPO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $55 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay.
Primary Care See details
The Humana Full Access H5216-132 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy with a $45 copay. The plan also covers physician specialist services with a $35 copay, and mental health and psychiatric services with no copay for individual and group sessions. Physical therapy and speech-language pathology services have a $45 copay, and additional telehealth benefits have a copay between $0 and $55. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Full Access H5216-132 (PPO) plan covers preventive services including an annual physical exam with no copay, and also covers additional services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. Some preventive services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams have a $35 copay, while routine hearing exams are covered with no copay for one exam every year, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a copay between $599 and $899 for two hearing aids per year, while OTC hearing aids are covered up to $50 every three months.
Vision Services See details
Humana Full Access H5216-132 (PPO) covers vision services including eye exams with a copay of $0-$35, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $35 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery with no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a maximum benefit of $2,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Full Access H5216-132 (PPO) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Full Access H5216-132 (PPO) plan, but require prior authorization. The coinsurance for this service is 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 10% coinsurance, while medical supplies and prosthetic devices also have a 10% coinsurance. Diabetic supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $55, while Lab Services have no copay; Diagnostic Radiological Services have a copay up to $350, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5216-132 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Full Access H5216-132 (PPO) plan, but are not covered in practice. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is a $10 copay, for days 21-50 the copay is $214, and for days 51-100 there is no copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Full Access H5216-132 (PPO) plan covers acupuncture with a $35 copay and covers over-the-counter items up to $50 every three months. The plan also offers a meal benefit with no copay, but other services like Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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