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Humana Value Plus H5216-161 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5216-161 (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 H5216-161 (PPO) in 2026, please refer to our full plan details page.
Humana Value Plus H5216-161 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Louisiana. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Plus H5216-161 (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 H5216-161 (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 H5216-161 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.90. 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 $10100.00 (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 $10100.00 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 H5216-161 (PPO) Medicare plan features an annual prescription drug deductible of $615. This means you will pay the full cost of your prescription medications up to this amount before your plan benefits begin to cover them. Specific drug coverage tier details, including copays and coinsurance rates for different medication levels, are not available for this plan. To determine your exact out-of-pocket costs, you should check the plan's formulary to see how your specific prescriptions are covered.
Additional Benefits
The Humana Value Plus H5216-161 (PPO) plan provides comprehensive healthcare coverage with no copay for primary care visits and a $35 copay for specialist consultations. For hospital care, inpatient stays require a $600 copay for days one through three and no copay for subsequent days, while emergency room visits carry a $130 copay. Additionally, members benefit from no copay on standard preventive services, annual physicals, and home health services. This plan also includes extensive routine care, offering dental services with no copay up to a $2,500 annual limit alongside routine vision exams and eyewear with no copay. Routine hearing exams and prescription hearing aids are covered with no copay, and members can access up to 36 one-way transportation trips to plan-approved locations at no cost. Additional perks like acupuncture, over-the-counter items, and meals for chronic illnesses are also available with no copay.
Inpatient Hospital See details
Humana Value Plus H5216-161 (PPO) covers inpatient acute hospital stays with no coinsurance, a $600 copay for days 1 through 3, and no copay for days 4 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, featuring a $550 copay for days 1 through 3 and no copay for days 4 through 90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Value Plus H5216-161 (PPO) covers outpatient hospital services with a 20% coinsurance and copays ranging from no copay to $35, while observation services require a $600 copay per stay. Ambulatory surgical center services feature no copay and 20% coinsurance, outpatient substance abuse sessions cost a $35 copay with no coinsurance, and outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Humana Value Plus H5216-161 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Humana Value Plus H5216-161 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 36 annual one-way trips to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Humana Value Plus H5216-161 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Value Plus H5216-161 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Physical and occupational therapy services are covered with no copay and 20% coinsurance, whereas chiropractic services are partially covered with a $0 to $15 copay and no coinsurance, excluding other chiropractic services which are not covered. Mental health, psychiatric, podiatry, and telehealth services are also covered with copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
Preventive services are covered by Humana Value Plus H5216-161 (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, and diabetes training. Additional preventive services are partially covered, offering memory fitness and in-home support with no copay and no coinsurance, but excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Humana Value Plus H5216-161 (PPO) covers hearing services, offering Medicare-covered exams for a $35 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two aids every three years, excluding inner ear, outer ear, and over the ear types.
Vision Services See details
Humana Value Plus H5216-161 (PPO) offers partially covered vision services with no deductible and no coinsurance, featuring one routine eye exam per year with no copay (up to a $75 limit) and eyewear coverage with no copay (up to a $250 annual limit). Other eye exam services, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Value Plus H5216-161 (PPO) partially covers dental services, offering Medicare-covered dental care with a $35 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $2,500 annual limit. While exams, cleanings, and various restorative procedures are covered, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Value Plus H5216-161 (PPO) covers home infusion bundled services, subject to prior authorization and step therapy. Covered Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%, while other Part B drugs feature no copay and chemotherapy drugs carry coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Value Plus H5216-161 (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Humana Value Plus H5216-161 (PPO) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, and diabetic supplies. Diabetic therapeutic shoes and inserts are covered with a $10 copay and coinsurance, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Humana Value Plus H5216-161 (PPO) covers diagnostic and radiological services with prior authorization, featuring a 20% coinsurance across most services. Lab services and outpatient X-rays require no copay, while diagnostic tests range from no copay up to a $50 copay, and therapeutic radiological services require a minimum $35 copay.
Home Health Services See details
Humana Value Plus H5216-161 (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 Humana Value Plus H5216-161 (PPO) with no copay and a 20% coinsurance, though prior authorization is required. This coverage extends to intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Value Plus H5216-161 (PPO) with no coinsurance, as additional days beyond the standard Medicare-covered limit are not covered. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with prior authorization required.
Other Services See details
Other services are partially covered by Humana Value Plus H5216-161 (PPO) with no copay and no coinsurance for acupuncture, over-the-counter items, and chronic illness meals. Sub-services such as Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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