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Humana Value Plus H5216-173 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5216-173 (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 H5216-173 (PPO) in 2026, please refer to our full plan details page.
Humana Value Plus H5216-173 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Plus H5216-173 (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 H5216-173 (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 H5216-173 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.10. 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 $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 $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
The Humana Value Plus H5216-173 (PPO) prescription drug plan features an annual drug deductible of $615. This deductible is the amount you must pay out of pocket for your medications before your plan coverage kicks in. Specific drug tier details, copayments, and coinsurance amounts are currently not available for this plan. To determine your exact costs for specific prescriptions, it is best to review the complete formulary for the Humana Value Plus H5216-173 (PPO) plan.
Additional Benefits
The Humana Value Plus H5216-173 (PPO) plan offers affordable coverage for core medical services, featuring no copay and no coinsurance for primary care and preventive visits. For specialized care, outpatient services and specialist visits generally require no copay and a 20% coinsurance. Inpatient hospital stays require a $1,882 copay per acute stay, while emergency room visits carry a $115 copay that is waived if you are admitted. Supplemental benefits include a comprehensive dental plan with a $5,000 annual limit and no copay or coinsurance for preventive care. Vision and hearing benefits offer partial coverage, including a $350 annual eyewear allowance and up to two over-the-counter hearing aids per year with no copay. Furthermore, home health services feature no copay or coinsurance, and skilled nursing facility stays are covered with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Value Plus H5216-173 (PPO) with no coinsurance, but require a $1,882 copay per stay for acute care and a $1,733 copay per stay for psychiatric care. Some services are not covered under this benefit, including upgrades and non-Medicare-covered stays.
Outpatient Services See details
Humana Value Plus H5216-173 (PPO) covers outpatient hospital, ambulatory surgical center, observation, and substance abuse services with a 20% coinsurance and no copay. Outpatient blood services are covered with no copay, no coinsurance, and no deductible, with prior authorization required for these outpatient services.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Value Plus H5216-173 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Value Plus H5216-173 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. While transportation services are technically covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Value Plus H5216-173 (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 30% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Value Plus H5216-173 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, and psychiatric services feature no copay and 20% coinsurance. Podiatry is not covered, telehealth requires no copay and 20% to 30% coinsurance, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services under the Humana Value Plus H5216-173 (PPO) plan are partially covered with no copay and no coinsurance for services such as annual physical exams, kidney disease education, and memory fitness. However, numerous additional preventive benefits are not covered, including health education, weight management programs, nutritional/dietary benefits, and in-home safety assessments.
Hearing Services See details
Hearing services under Humana Value Plus H5216-173 (PPO) include routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, excluding inner ear, outer ear, and over-the-ear models, while up to two over-the-counter (OTC) hearing aids are covered each year with no copay or coinsurance.
Vision Services See details
Humana Value Plus H5216-173 (PPO) partially covers vision services, providing one routine eye exam per year with no copay and 20% coinsurance up to a $40 limit, while other eye exams are not covered. Eyewear is also partially covered with no copay and no coinsurance up to a $350 annual limit for one pair of contacts or eyeglasses, but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Value Plus H5216-173 (PPO) offers partially covered dental services with an annual maximum benefit of $5,000, featuring no copay and no coinsurance for preventive care, diagnostic exams, fillings, root canals, and extractions. Medicare-covered dental services require a 20% coinsurance, while fixed and removable prosthodontics require a 30% coinsurance, both with no copay. Fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered under this plan.
Home Infusion bundled Services See details
Humana Value Plus H5216-173 (PPO) covers Home Infusion bundled services, requiring prior authorization and step therapy for some drugs. Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, with insulin requiring a $35 copay (with no deductible) and other Part B drugs having no copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Value Plus H5216-173 (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 H5216-173 (PPO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Value Plus H5216-173 (PPO) covers diagnostic and radiological services, including lab work, diagnostic tests, therapeutic radiology, and X-rays, with a 20% coinsurance and no copay. Prior authorization is required for these services.
Home Health Services See details
Home health services are covered under the Humana Value Plus H5216-173 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Value Plus H5216-173 (PPO) offers cardiac rehabilitation services with no copay and prior authorization, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Humana Value Plus H5216-173 (PPO) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the Humana Value Plus H5216-173 (PPO) are partially covered, featuring acupuncture with no copay and 20% coinsurance, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Dual Eligible SNPs and other miscellaneous services are not covered under this benefit.
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