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HumanaChoice H5216-136 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-136 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-136 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-136 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Mississippi. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-136 (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 H5216-136 (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 H5216-136 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $33.00. 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 has a $400.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 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 $9800.00 (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 $9800.00 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 H5216-136 (PPO) plan features an annual prescription drug deductible of $590. Under this plan, Tier 1 preferred generic drugs have no copay when filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost a low $5 copay for a one-month supply at standard pharmacies, and there is no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply at standard pharmacies and mail order, with a discounted $131 copay for a three-month supply through preferred mail order. Higher-tier prescriptions are subject to coinsurance, with Tier 4 non-preferred drugs requiring 36% coinsurance and Tier 5 specialty drugs requiring 26% coinsurance.
Additional Benefits
The HumanaChoice H5216-136 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, home health services, and covered preventive care. Specialist visits require a $40 copay, while inpatient hospital stays carry a $275 daily copay for the first 5 to 7 days with no copay thereafter. Emergency care is accessible with a $130 copay, which is waived upon hospital admission, and urgent care visits require a $50 copay. Additional benefits include dental coverage up to a $1,500 annual limit with no copay for preventive services, alongside vision and hearing benefits that offer routine exams with no copay. Diagnostic lab work and outpatient X-rays also feature no copay, whereas medical equipment and dialysis services require a 20% coinsurance. Most services under this plan feature no coinsurance, helping to keep your healthcare costs predictable and manageable.
Inpatient Hospital See details
HumanaChoice H5216-136 (PPO) covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for remaining days. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-136 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $275, observation services cost a $275 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-136 (PPO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-136 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, with prior authorization required for all ambulance services. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-136 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-136 (PPO) covers primary care physician visits with no copay and specialist visits with a $40 copay, both with no coinsurance. Physical and occupational therapies require a $25 copay with no coinsurance, while podiatry is not covered, and only some chiropractic services are covered because routine and other chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-136 (PPO) preventive services are partially covered with no copay and no coinsurance for covered services, including annual physical exams, kidney disease education, fitness benefits, and in-home support. However, several supplemental preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
HumanaChoice H5216-136 (PPO) covers hearing services, including Medicare-covered exams for a $40 copay and routine exams or fitting evaluations for no copay, all with no coinsurance. Prescription hearing aids are partially covered with a copay of $699 to $999 and no coinsurance for up to two devices per year, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-136 (PPO) vision services are partially covered, featuring no coinsurance for all services, a $0 to $40 copay for eye exams, and no copay for contact lenses and eyeglasses. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
HumanaChoice H5216-136 (PPO) offers partially covered dental services up to a $1,500 annual limit, though fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Preventive care and several comprehensive services feature no copay and no coinsurance, while Medicare-covered dental requires a $40 copay and no coinsurance, and restorative or prosthodontic services have no copay and 30% to 40% coinsurance.
Home Infusion bundled Services See details
HumanaChoice H5216-136 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-136 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-136 (PPO) covers medical equipment, offering durable medical equipment, prosthetic devices, 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 and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-136 (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab services, outpatient X-rays, and diagnostic radiology. Diagnostic procedures have no coinsurance and a copay ranging from $0 to $75, while therapeutic radiological services require a 20% coinsurance and a $40 copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-136 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-136 (PPO) with no coinsurance and a $15 copay, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-136 (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
HumanaChoice H5216-136 (PPO) partially covers other services, featuring acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Prior authorization is required for both of these covered benefits, while over-the-counter (OTC) items are not covered.
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