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HumanaChoice H5216-157 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-157 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-157 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-157 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Georgia and South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-157 (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 H5216-157 (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 H5216-157 (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 $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
Prescription drugs are not covered by HumanaChoice H5216-157 (PPO).
Additional Benefits
The HumanaChoice H5216-157 (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, patients pay a $45 copay, while emergency care requires a $115 copay. Inpatient hospital stays require a $375 daily copay for the first few days with no coinsurance, and skilled nursing facility stays are covered with no copay for the first 20 days. This plan also includes key supplemental benefits, such as dental coverage up to a $2,500 annual limit with no copay for preventive and comprehensive services, though coinsurance ranges from 0% to 40%. Routine vision and hearing exams are available with no copay, and prescription hearing aids are partially covered with copays ranging from $699 to $999. For medical equipment and dialysis services, members can expect no copay and a standard 20% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-157 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 7 of acute stays (no copay for days 8 and beyond) and a $375 daily copay for days 1 through 5 of psychiatric stays (no copay for days 6 through 90). Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
HumanaChoice H5216-157 (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $450 for outpatient hospital services and $375 per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services require a $35 copay per session with no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-157 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-157 (PPO) covers ground and air ambulance services with a $335 copayment and no coinsurance, though prior authorization is required and the copay is not waived if you are admitted to the hospital. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-157 (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 covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-157 (PPO) offers primary care physician visits with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Covered therapy services carry a $25 copay and mental health services require a $35 copay with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
HumanaChoice H5216-157 (PPO) covers key preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered; the plan includes a memory fitness benefit with no copay and no coinsurance, but does not cover services such as health education, in-home safety assessments, and nutritional benefits.
Hearing Services See details
Hearing services are covered under HumanaChoice H5216-157 (PPO), offering routine hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-157 (PPO), which offers one routine eye exam and one pair of eyeglasses or contact lenses per year with no copay, no coinsurance, and no deductible. Prior authorization is required, and benefits are capped at a $75 annual limit for exams and a $150 annual limit for eyewear, while upgrades, separate lenses or frames, and other eye exams are not covered.
Dental Services See details
HumanaChoice H5216-157 (PPO) offers partially covered dental services with a $2,500 annual maximum, though fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and coinsurance ranging from 0% to 40%.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5216-157 (PPO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-157 (PPO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-157 (PPO), including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with prior authorization required for most items. DME, prosthetics, and medical supplies carry a 20% coinsurance with no copay, while diabetic supplies feature a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-157 (PPO) covers diagnostic and radiological services, offering lab services, outpatient X-rays, and diagnostic radiology with no copay. Diagnostic procedures carry a $0 to $120 copay with no coinsurance, while therapeutic radiology requires a minimum 20% coinsurance and a $45 copay.
Home Health Services See details
HumanaChoice H5216-157 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-157 (PPO) with no coinsurance and require prior authorization, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, which otherwise carry copayments ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-157 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered by HumanaChoice H5216-157 (PPO) include acupuncture, which has a $45.00 copay, no coinsurance, and a 20-treatment annual limit, as well as over-the-counter items with no copay and no coinsurance. Meal benefits and other extra services are not covered under this plan.
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