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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 2026, 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 2026.
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 affordable medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For specialized medical needs, members pay a $35 copay for specialist visits and a $460 copay per admission for inpatient hospital stays. Emergency care is available with a $150 copay, which is waived if admitted, while urgent care visits require a $65 copay. This plan also features robust supplemental benefits, including routine dental, vision, and hearing exams with no copay, alongside a $1,750 annual limit for dental care. Skilled nursing facility stays have no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance and no copay. Additionally, diagnostic labs and outpatient X-rays are fully covered with no copay or coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-152 (PPO) covers inpatient acute and psychiatric hospital stays with a $460 copay per admission and no coinsurance, though prior authorization is required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
HumanaChoice H5216-152 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $460 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-152 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-152 (PPO) offers partial coverage for ambulance and transportation services, with Medicare-covered ground and air ambulance services requiring a $335 copay and no coinsurance. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-152 (PPO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-152 (PPO) covers primary care visits with no copay and no coinsurance, while specialist, mental health, psychiatric, and opioid treatment services require a $35 copay and no coinsurance. Therapy services carry a $10 to $35 copay with no coinsurance, telehealth ranges from no copay to a $65 copay, and podiatry and chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-152 (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, and select screenings. However, several supplemental services, including health education, nutritional benefits, and in-home support, are not covered under this plan.
Hearing Services See details
HumanaChoice H5216-152 (PPO) offers hearing services with no deductible and no coinsurance, featuring a $35 copay for Medicare-covered exams, and no copay for routine exams, fittings, and OTC hearing aids. Prescription hearing aids are partially covered with a copay ranging from $399 to $699 for up to two devices per year, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
HumanaChoice H5216-152 (PPO) offers partially covered vision services with no deductibles, no coinsurance, a $0 to $35 copay for eye exams, and no copay for covered eyewear. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered up to yearly allowance limits, but other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-152 (PPO), offering up to a $1,750 annual limit for combined in-network and out-of-network care. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though fluoride, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-152 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while covered insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice H5216-152 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-152 (PPO), with durable medical equipment, prosthetics, and medical supplies requiring 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 H5216-152 (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a copay of $0 to $120 for diagnostic tests and procedures. Covered radiological services include outpatient X-rays and diagnostic radiology with no copay, while therapeutic radiological services require a minimum 20% coinsurance and a $35 copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-152 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5216-152 (PPO) plan, as none of the individual sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy—are covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice H5216-152 (PPO) with no coinsurance and no prior 3-day hospital stay required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with prior authorization required and no coverage for days beyond the Medicare limit.
Other Services See details
Other services are partially covered by HumanaChoice H5216-152 (PPO), featuring acupuncture for a $35 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while other optional services and Dual Eligible SNPs with Highly Integrated Services are not covered.
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