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Humana Value Plus H5216-160 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5216-160 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Plus H5216-160 (PPO) in 2025, please refer to our full plan details page.
Humana Value Plus H5216-160 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Mississippi. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Value Plus H5216-160 (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 Humana Value Plus H5216-160 (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 Humana Value Plus H5216-160 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.50. 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 $590.00 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:
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Drug Coverage
The Humana Value Plus H5216-160 (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach the $2000 threshold, you enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs. The plan's premium may be reduced if you qualify for the low-income subsidy, also known as "Extra help".
Additional Benefits
The Humana Value Plus H5216-160 (PPO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient and outpatient services, with copays and coinsurance depending on the specific service. It also provides coverage for preventive services, hearing, vision, and dental, with some services at no cost and others with copays or coinsurance. Additional benefits include ambulance and transportation services, emergency services, and home health services with no copay. The plan also covers durable medical equipment, diagnostic and radiological services, and skilled nursing facility services, with copays or coinsurance applying to some of these services. This plan also covers acupuncture, a meal benefit, and has a maximum annual dental benefit of $2500.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered. For acute inpatient hospital stays, you will pay a $728 copay for days 1-3, and no copay for days 4-90. For days 91-999, there is no copay. For psychiatric inpatient hospital stays, you will pay a $678 copay for days 1-3, and no copay for days 4-90. Additional days for inpatient psychiatric hospital are not covered. Non-Medicare-covered stays and upgrades for inpatient hospital are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a $0-$30 copay and 20% coinsurance, observation services with a $728 copay, ambulatory surgical center services with a 20% coinsurance, outpatient substance abuse services with a 20% coinsurance, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Value Plus H5216-160 (PPO) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $315 copay, air ambulance services with 20% coinsurance, and transportation services to plan-approved health-related locations with no copay for up to 48 one-way trips per year. 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. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a $45 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $110 copay.
Primary Care See details
Humana Value Plus H5216-160 (PPO) covers primary care physician services with no copay, and covers chiropractic services with 20% coinsurance. This plan also covers occupational therapy services and physical therapy and speech-language pathology services with 20% coinsurance, physician specialist services with a $30 copay, and mental health specialty services with 20% coinsurance. Additionally, this plan covers additional telehealth benefits with 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services are covered with a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
The Humana Value Plus H5216-160 (PPO) plan covers preventive services, including an annual physical exam with no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are covered with no copay. Additional preventive services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, and routine hearing exams with no copay and one visit covered every year. Prescription hearing aids are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $30, with coverage for routine eye exams. Eyewear is covered with no copay, and includes contact lenses and eyeglasses (lenses and frames) with a combined maximum benefit of $550 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Value Plus H5216-160 (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a maximum plan benefit of $2500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay and a coinsurance between 0-19%, and other Medicare Part B drugs have a coinsurance between 0-19% with no copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Value Plus H5216-160 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Humana Value Plus H5216-160 (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies are covered with 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts are covered with no copay.
Diagnostic and Radiological Services See details
For Humana Value Plus H5216-160 (PPO), Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a coinsurance of at most 20% and a copay up to $45, lab services with a coinsurance of at most 20% and no copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with a coinsurance of at most 20% and a copay up to $30, and outpatient X-ray services with a coinsurance of at most 20% and no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Humana Value Plus H5216-160 (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 by the Humana Value Plus H5216-160 (PPO) plan, but the plan 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 Humana Value Plus H5216-160 (PPO) plan, with a prior authorization requirement. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Value Plus H5216-160 (PPO) plan covers acupuncture with no copay, and a limit of 20 treatments per year, and also covers a meal benefit with no copay. Over-the-counter items, 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 are not covered.
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