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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 2026, 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 Mississippi. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $23.80. 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 $13800.00 (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 $13800.00 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) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share of the costs. Understanding this upfront cost is highly important when evaluating your overall healthcare budget for the year. Specific drug coverage tier details, including individual copayments and coinsurance rates for different medication levels, are currently unavailable for this plan. To determine your exact coverage and costs for specific prescriptions, you should consult the plan's formulary or contact the provider directly.
Additional Benefits
The Humana Value Plus H5216-160 (PPO) plan offers comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care doctor visits and preventive care. Specialist visits require a $25 copay, while inpatient hospital stays require a $728 copay for days one through three and no copay for additional days. Outpatient services are available with copays ranging from no copay to $35 and 20% coinsurance. This plan also provides valuable supplemental benefits, including routine dental, vision, and hearing care with no copay, alongside up to 60 free one-way trips to approved health locations. Emergency services carry a $115 copay, which is waived upon hospital admission, and urgent care costs a $40 copay. Additionally, home health services, acupuncture, and select over-the-counter items are covered with no copay and no coinsurance.
Inpatient Hospital See details
Humana Value Plus H5216-160 (PPO) covers inpatient acute hospital stays with no coinsurance, requiring prior authorization and a $728 copay for days 1 through 3, with no copay for days 4 and beyond. Inpatient psychiatric care is covered with no coinsurance and a $678 copay for days 1 through 3, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Value Plus H5216-160 (PPO) covers outpatient hospital services with a $0 to $35 copay and 20% coinsurance, and observation services with a $728 copay per stay plus coinsurance. Ambulatory surgical center services require no copay and 20% coinsurance, while outpatient substance abuse sessions carry a $35 copay with no coinsurance, and blood services have no copay and no coinsurance.
Partial Hospitalization See details
Humana Value Plus H5216-160 (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
Humana Value Plus H5216-160 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Additionally, the plan covers up to 60 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Humana Value Plus H5216-160 (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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance, none of which count toward the plan-level deductible.
Primary Care See details
Primary care benefits under the Humana Value Plus H5216-160 (PPO) plan feature no copay and no coinsurance for primary care doctor visits, while specialist visits require a $25 copay and no coinsurance. Physical and occupational therapy are covered with no copay and 20% coinsurance, chiropractic services are partially covered (routine and other chiropractic services are not covered) with a $15 copay and no coinsurance, and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Value Plus H5216-160 (PPO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, glaucoma screenings, diabetes training, and fitness benefits. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Value Plus H5216-160 (PPO) offers hearing services with no copay and no coinsurance for routine exams, fitting evaluations, and OTC hearing aids, while Medicare-covered exams require a $25 copay and no coinsurance. Some prescription hearing aid services are covered with no copay and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Value Plus H5216-160 (PPO) vision services are partially covered, featuring no coinsurance and copays ranging from $0 to $25 for exams and eyewear. While routine eye exams, contact lenses, and complete eyeglasses are covered with no copay, other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Value Plus H5216-160 (PPO) partially covers dental services, offering Medicare-covered dental with a $25 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $2,500 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Value Plus H5216-160 (PPO) covers Home Infusion bundled Services with prior authorization, offering covered insulin for a $35 copay and coinsurance ranging from no coinsurance to 20%. Other Medicare Part B drugs, including chemotherapy and radiation, have coinsurance ranging from no coinsurance to 20%, with no copay for other Part B drugs.
Dialysis Services See details
Humana Value Plus H5216-160 (PPO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Value Plus H5216-160 (PPO) covers durable medical equipment, prosthetics, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with a $10 copay, and prior authorization is required for most medical equipment.
Diagnostic and Radiological Services See details
Humana Value Plus H5216-160 (PPO) covers diagnostic and radiological services with prior authorization, offering lab and outpatient X-ray services with no copay and a minimum 20% coinsurance. Diagnostic tests and procedures have a $0 to $40 copay and a minimum 20% coinsurance, while therapeutic radiological services require a minimum $25 copay and a minimum 20% coinsurance.
Home Health Services See details
Humana Value Plus H5216-160 (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 offered by Humana Value Plus H5216-160 (PPO) with no copay and prior authorization required, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Value Plus H5216-160 (PPO) covers skilled nursing facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Humana Value Plus H5216-160 (PPO) are partially covered, offering acupuncture, over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and some drugs on the CMS OTC list are not covered.
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