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Humana Full Access H5216-133 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-133 (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 H5216-133 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access H5216-133 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Macomb, Oakland and Wayne counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Full Access H5216-133 (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 H5216-133 (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 H5216-133 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $11.00. 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 $200.00 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 Full Access H5216-133 (PPO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $10 copay for preferred generic drugs at a standard or preferred mail pharmacy, and 50% coinsurance for preferred brand drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Humana Full Access H5216-133 (PPO) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays with a copay, outpatient services with copays, and services such as primary care, preventive care, hearing, vision, and dental, each with its own copay structure. Additional benefits include ambulance services, emergency services, and home health services, along with coverage for medical equipment and diagnostic services. The plan also covers services like partial hospitalization, skilled nursing facilities, and dialysis, but other services such as home infusion, dental, and medical equipment have coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a copay of $530 for days 1-5, and no copay for days 6-90, and Inpatient Hospital Psychiatric with a copay of $530 for days 1-4, and no copay for days 5-90. Additional Days for Inpatient Hospital-Acute is also covered with no copay for days 91-999. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by Humana Full Access H5216-133 (PPO). Outpatient Hospital Services have a copay between $0 and $530, while Observation Services have a copay of $530. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have copays between $60 and $85 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The Humana Full Access H5216-133 (PPO) plan covers both ground and air ambulance services with a copay of $315.00. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Humana Full Access H5216-133 (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The Humana Full Access H5216-133 (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a $45 copay, and physician specialist services have a $60 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $60-$85 copay depending on the service, and physical therapy and speech-language pathology services have a $45 copay. Additional telehealth benefits range from no copay to a $60 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services, including fitness benefits, and kidney disease education services. Additional services like health education, in-home safety assessment, personal emergency response system, and more are not covered. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Humana Full Access H5216-133 (PPO) plan covers hearing exams with a $60 copay. Routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a copay between $299 and $599, while OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$60, routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $3,000 maximum benefit per year. Medicare Dental Services have a $60 copay. Other services include 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, which all have no copay; prosthodontics (removable and fixed) have 30% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%. Other Medicare Part B Drugs have no copay and coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs, there is coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Full Access H5216-133 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, Diabetic Supplies with 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a coinsurance of at most 20% and a copay of at most $60, Lab Services with no copay, Diagnostic Radiological Services with a coinsurance of at most 20% and a copay of at most $720, and Therapeutic Radiological Services with a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5216-133 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. This benefit requires prior authorization, and the cost sharing details for the covered services are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Full Access H5216-133 (PPO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture and meal benefits. Acupuncture has a $60 copay and is limited to 20 treatments per year, while meal benefits have no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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