A non-government entity
HumanaChoice H5216-142 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-142 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-142 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-142 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in GA, SC and AL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-142 (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 H5216-142 (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 H5216-142 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $350.00 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 $14000.00 (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 $14000.00 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:
Sign up for HumanaChoice H5216-142 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5216-142 (PPO) plan has a $350 deductible for prescription drugs. After meeting the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for preferred generic drugs, you will pay a $12 copay at a standard pharmacy and a $20 copay at a standard mail-order pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $21.
Additional Benefits
The HumanaChoice H5216-142 (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. It also provides coverage for services like primary care, hearing, vision, and dental, often with no copay or a low copay. This plan includes coverage for emergency services, ambulance, and home health services, as well as several other services like home infusion, dialysis, and medical equipment. Additionally, the plan offers preventive services and covers prescription hearing aids, with a yearly maximum for dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $394 copay for days 1-6, and no copay for days 7-90, while additional days (91-999) have no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $394 copay for days 1-5, and no copay for days 6-90; additional days and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $0-$450, and observation services with a copay of $394. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $45-$100 for individual or group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-142 (PPO) plan, but requires prior authorization. The copay for this service is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-142 (PPO) plan. Ground and air ambulance services have a $315 copay, and there is no coinsurance. 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 by HumanaChoice H5216-142 (PPO). Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice H5216-142 (PPO) plan covers primary care physician services and chiropractic services with a $15 copay. Occupational therapy services have a $25 copay, while physician specialist services have a $45 copay. Mental health specialty services, podiatry services, psychiatric services, and Opioid Treatment Program Services have a $45 minimum copay. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay ranging from $0 to $45.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, as well as other preventive services like Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit, all with no copay. Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefits, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices, and Counseling Services are not covered.
Hearing Services See details
HumanaChoice H5216-142 (PPO) covers hearing exams with a $45 copay and routine hearing exams with no copay. Prescription hearing aids are partially covered, with the plan covering "all types" of hearing aids with a copay between $699 and $999, but not covering inner, outer, or over-the-ear hearing aids. OTC hearing aids are covered with a maximum benefit of $60 every three months.
Vision Services See details
The HumanaChoice H5216-142 (PPO) plan covers eye exams with a copay of $0-$45, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-142 (PPO) plan covers dental services, including oral exams with no copay, and dental x-rays with no copay. 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 are covered with no copay, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $1,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HumanaChoice H5216-142 (PPO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as other Medicare Part B drugs with a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment is covered by the HumanaChoice H5216-142 (PPO) plan, including Durable Medical Equipment (DME) with 4% coinsurance and Prosthetics/Medical Supplies, with 20% coinsurance for Medicare-covered items, and Diabetic Equipment, with a 10% coinsurance for Diabetic Supplies and a $10 copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services, with a maximum copay of $120.00. Radiological Services are covered, with a copay for Medicare-covered diagnostic and therapeutic radiological services, and outpatient X-ray services have a $15 copay, while therapeutic radiological services have a 20% coinsurance and a maximum copay of $50.00.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-142 (PPO) plan with no copay and no coinsurance, however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-142 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-142 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The HumanaChoice H5216-142 (PPO) plan covers acupuncture with a $45 copay, and also covers a meal benefit with no copay. Over-the-counter items are covered up to $60 every three months, and the plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved