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HumanaChoice H5216-152 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-152 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-152 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-152 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-152 (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice H5216-152 (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 H5216-152 (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.
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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3400.00 (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 $3400.00 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
Prescription drugs are not covered by HumanaChoice H5216-152 (PPO).
Additional Benefits
The HumanaChoice H5216-152 (PPO) plan offers a range of benefits, including inpatient hospital stays with a $460 copay per admission, outpatient services with varying copays, and emergency services with a $135 copay. This plan covers primary care with no copay, preventive services, hearing exams with a $35 copay, vision services with no copay for routine eye exams and eyewear, and dental services with a $1,500 annual maximum. Additional benefits include home health services with no copay, home infusion services with a copay and coinsurance for certain drugs, and medical equipment with coinsurance. Other notable features are coverage for ambulance services with a $300 copay, and skilled nursing facility stays with no copay for the first 20 days. The plan also provides coverage for additional services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered. The plan has a copay of $460 per admission for Medicare-covered stays, with additional days for inpatient hospital-acute covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $300, observation services with a $460 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay between $35 and $85 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-152 (PPO) plan, with a $35 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HumanaChoice H5216-152 (PPO) plan. Ground and Air Ambulance services have a $300 copay with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the HumanaChoice H5216-152 (PPO) plan. For Emergency Services, you will pay a $135 copay, and for Urgently Needed Services, the copay is $65, with no coinsurance for either service. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $135 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay, and Chiropractic Services are covered with a $20 copay. Occupational Therapy Services have a copay between $10 and $35, and Physician Specialist Services have a $35 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a copay between $35 and $85. Physical Therapy and Speech-Language Pathology Services have a copay between $10 and $35, and Additional Telehealth Benefits have a copay between $0 and $65. Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice H5216-152 (PPO) plan covers preventive services, including annual physical exams with no copay. Additional preventive services, kidney disease education, and other preventive services are covered with a copay, and some services require prior authorization. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, 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 modifications, and counseling services are not covered. The plan also covers wigs for hair loss related to chemotherapy and fitness benefits with no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams have no copay. Fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with a maximum of $75 every three months.
Vision Services See details
The HumanaChoice H5216-152 (PPO) plan covers eye exams with a copay between $0 and $35, routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-152 (PPO) plan offers dental services with a $1,500 annual maximum. Medicare Dental Services have a $35 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Other Preventive Dental Services, and Prophylaxis (Cleaning) have no coinsurance. Fluoride Treatment, Endodontics, Prosthodontics (removable, fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The cost for Medicare Part B Insulin Drugs includes a $35 copay and a coinsurance between 0% and 20%, while the cost for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs includes a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-152 (PPO) plan, with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $85, Lab Services with no copay, Diagnostic Radiological Services with a copay between $75 and $295, Therapeutic Radiological Services with a copay of at least $35 and coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-152 (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, but the plan does not cover the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required, and there is a copay for covered services, though the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-152 (PPO) plan, but require prior authorization. For days 1-20, there is no copay; for days 21-38, the copay is $196, and for days 39-100, there is no copay.
Other Services See details
Other Services includes acupuncture with a $35 copay, over-the-counter items with a $75 maximum benefit every three months, and a meal benefit with no copay. This plan does not cover 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.
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