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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 2025, 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 2025.
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 $47.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $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) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your Part D premium will be $47.30. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Value Plus H5216-161 (PPO) plan offers a range of benefits with varying cost-sharing. The plan includes no copay for primary care, preventive services, home health services, vision services, dental services, and many other services, with coinsurance or copays for services like outpatient services, specialist visits, and emergency care. Coverage extends to areas like hearing, vision, and dental, with specific copays and limitations.
Inpatient Hospital See details
Inpatient Hospital benefits under the Humana Value Plus H5216-161 (PPO) plan include coverage for Inpatient Hospital-Acute with a $600 copay for days 1-3, and no copay for days 4-90, and Inpatient Hospital Psychiatric with a $550 copay for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the Humana Value Plus H5216-161 (PPO) plan, including outpatient hospital services with a 20% coinsurance and a copay between $0 and $35, observation services with a $600 copay, Ambulatory Surgical Center (ASC) services with a 20% coinsurance, outpatient substance abuse services with a 20% coinsurance, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Value Plus H5216-161 (PPO) plan, but requires prior authorization. You will pay 18% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance, and transportation services have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $110 copay. Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Transportation has a $110 copay.
Primary Care See details
The Humana Value Plus H5216-161 (PPO) plan offers primary care services with no copay, chiropractic services with 20% coinsurance and routine care with no copay, occupational therapy services with 20% coinsurance, physician specialist services with a $35 copay, mental health specialty services with 20% coinsurance, podiatry services with a $0-$35 copay, other health care professional services with a $0-$35 copay, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with 20% coinsurance, additional telehealth benefits with 20% coinsurance and a $0-$35 copay, and opioid treatment program services with 20% coinsurance.
Preventive Services See details
Preventive services include Medicare-covered preventive services, an annual physical exam with no copay, and additional preventive services, though some services like health education and home-based palliative care are not covered. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit all have no copay.
Hearing Services See details
The Humana Value Plus H5216-161 (PPO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay for one visit every year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Value Plus H5216-161 (PPO) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Value Plus H5216-161 (PPO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $35 copay for Medicare dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%, and no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Value Plus H5216-161 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the Humana Value Plus H5216-161 (PPO) plan. Durable Medical Equipment has an 18% coinsurance and no copay, while Prosthetic Devices have a 20% coinsurance. Medical Supplies have a 20% coinsurance and Diabetic Supplies have a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with coinsurance and copayments for some services. Diagnostic Procedures/Tests have a maximum copay of $35 and a minimum coinsurance of 20%, while Lab Services have no copay and a minimum coinsurance of 20%. Diagnostic Radiological Services have a maximum copay of $310.00, Therapeutic Radiological Services have a maximum copay of $35.00 and a minimum coinsurance of 20%, and Outpatient X-Ray Services have no copay and a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Humana Value Plus H5216-161 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not provide coverage for Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Value Plus H5216-161 (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Value Plus H5216-161 (PPO) plan covers acupuncture with no copay, up to 20 treatments per year, but requires prior authorization. Meal benefits are covered with no copay and require prior authorization. Other services, including over-the-counter items, are not covered.
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