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Humana Value Plus H5216-176 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5216-176 (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 H5216-176 (PPO) in 2025, please refer to our full plan details page.
Humana Value Plus H5216-176 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Minnesota. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Value Plus H5216-176 (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 H5216-176 (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 H5216-176 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.60. 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 H5216-176 (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $590. After the deductible, you will pay 25% coinsurance for many drugs depending on the tier and pharmacy. During the initial coverage phase, you will pay the costs for your drugs until the total drug costs reach $2000. After this, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Value Plus H5216-176 (PPO) plan provides a variety of benefits, including inpatient and outpatient hospital services, with varying copays and coinsurance. This plan also covers services like ambulance, emergency, and primary care, with specific copays and coinsurance amounts. Additional benefits include preventive, hearing, vision, dental, home infusion, dialysis, and medical equipment coverage.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a copay of $2,185 per admission or stay, and Inpatient Hospital Psychiatric with a copay of $2,036 per admission or stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient Hospital Services have a 20% coinsurance and no copay, while Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services are covered with a 20% coinsurance and no copay. Outpatient Substance Abuse Services are covered, with a 20% coinsurance for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Value Plus H5216-176 (PPO) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Value Plus H5216-176 (PPO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance. 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 under the Humana Value Plus H5216-176 (PPO) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a 20% coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. Mental Health and Psychiatric Services, and Opioid Treatment Program Services also have a 20% coinsurance. Routine Chiropractic Care is not covered, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, modifications, and counseling services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Humana Value Plus H5216-176 (PPO) covers hearing exams with at most 20% coinsurance and no copay for Routine Hearing Exams, and no copay for Fitting/Evaluation for Hearing Aid. Prescription Hearing Aids (all types) have a copay between $699 and $999, while Inner Ear, Outer Ear, and Over the Ear Prescription Hearing Aids, and OTC Hearing Aids are not covered.
Vision Services See details
The Humana Value Plus H5216-176 (PPO) plan covers vision services including eye exams with a 20% coinsurance and no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Value Plus H5216-176 (PPO) plan covers Medicare Dental Services with 20% coinsurance after prior authorization and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Insulin drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, with no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Value Plus H5216-176 (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment are covered. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests and Therapeutic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at most $350 and a coinsurance of at most 20%, and Outpatient X-Ray Services have a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Value Plus H5216-176 (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, but the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required, and coinsurance applies.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Value Plus H5216-176 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
For the Humana Value Plus H5216-176 (PPO) plan, the Other Services benefit includes acupuncture with 20% coinsurance and a limit of 20 treatments per year, and 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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