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HumanaChoice H5216-144 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-144 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-144 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-144 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Richmond-Tidewater Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-144 (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 H5216-144 (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 H5216-144 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.00. 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 $13900.00 (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 $13900.00 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 H5216-144 (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will enjoy no copay when using standard pharmacies or preferred mail order services. Tier 2 generic medications are also highly affordable, costing a $5 copay for a one-month supply at standard pharmacies and offering no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply across standard pharmacies and mail-order options. For higher-tier medications, you will pay coinsurance rather than a flat copay, which includes a 44% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. This clear pricing structure allows you to easily anticipate your out-of-pocket medication costs.
Additional Benefits
The HumanaChoice H5216-144 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive care, and home health services. For specialist visits, urgent care, and emergency services, members pay manageable flat copayments, such as forty dollars for specialists and one hundred fifteen dollars for emergency care. Inpatient hospital stays require a three hundred seventy-five dollar daily copay for the first seven days of acute stays, with no copay required for additional days. Additionally, this plan provides valuable coverage for dental, vision, and hearing services, featuring no copay for preventive dental care and routine hearing exams, alongside low-to-no copays for eye exams. While diagnostic lab tests and outpatient X-rays have no copay, specialized services like dialysis and durable medical equipment require a twenty percent coinsurance. Prescription hearing aids and eyewear are also covered up to certain limits, helping you manage out-of-pocket costs for your everyday health needs.
Inpatient Hospital See details
HumanaChoice H5216-144 (PPO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays (no copay for days 8 and beyond) and a $375 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-144 (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital copays range from $0 to $450, observation services carry a $375 copay per stay, and outpatient substance abuse sessions require a $35 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-144 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-144 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice H5216-144 (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 are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-144 (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, and speech therapies carry a $25 copay and no coinsurance, while mental health and psychiatric sessions require a $35 copay and no coinsurance. Podiatry services are not covered, and although some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
HumanaChoice H5216-144 (PPO) provides partially covered preventive services with no copay and no coinsurance for covered options such as annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs, and a memory fitness benefit. Supplemental services not covered under this benefit include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-144 (PPO) offers partially covered hearing services with no coinsurance, including a $40 copay for Medicare-covered exams and no copay for one annual routine exam and unlimited fitting evaluations. Prescription hearing aids are covered for up to two devices per year with copays ranging from $699 to $999, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-144 (PPO) provides partially covered vision services with no deductible and no coinsurance. Eye exams feature a $0 to $40 copay, and covered eyewear has no copay up to a $100 annual limit, though other eye exam services, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-144 (PPO) features partially covered dental services, requiring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and diagnostic care. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-144 (PPO) covers Home Infusion bundled Services with no copay, although prior authorization and step therapy are required. Medicare Part B drugs, including chemotherapy, radiation, and other drugs, have no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-144 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-144 (PPO) covers medical equipment, offering durable medical equipment, prosthetics, 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 or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-144 (PPO) with prior authorization, featuring no coinsurance and no copay for lab services, alongside a $0 to $120 copay for diagnostic procedures. Outpatient X-rays require no copay, while diagnostic radiological services start at a $0 copay and therapeutic radiological services require a minimum 20% coinsurance and $40 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-144 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-144 (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though in practice only some services are covered and prior authorization is required. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and SET for PAD services ($20 copay) are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-144 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day inpatient hospital stay is needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-144 (PPO) partially covers other services, offering acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, subject to prior authorization. Over-the-counter (OTC) items, meal benefits, and other additional services are not covered under this plan.
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