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Humana Value Plus H5216-179 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5216-179 (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 H5216-179 (PPO) in 2026, please refer to our full plan details page.
Humana Value Plus H5216-179 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Alabama. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Plus H5216-179 (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 H5216-179 (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 H5216-179 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.70. 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 has a $150.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $5750.00 (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 $5750.00 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 H5216-179 (PPO) prescription drug plan features a $615.00 annual drug deductible under its Defined Standard benefit type. After meeting this deductible, you will share costs for covered medications during the initial coverage phase until your total drug costs reach $2,100.00. Additionally, individuals who qualify for the low-income subsidy, also known as Extra Help, may see their Part D premium reduced to $27.70. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for Medicare Part D covered drugs. During this phase, you pay nothing for covered Part D medications, though you may still pay a share of the costs for any excluded drugs.
Additional Benefits
The Humana Value Plus H5216-179 (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $210 daily copay for days 1 through 4, followed by no copay for days 5 through 90 with no coinsurance. Emergency room visits require a $150 copay, which is waived if admitted within 24 hours, while outpatient hospital services require up to a $30 copay with 20% coinsurance. This plan also includes valuable supplemental benefits, featuring a $2,500 annual limit on covered dental services with no copay and a $250 annual allowance for eyewear with no coinsurance. Routine eye and hearing exams, over-the-counter hearing aids, and up to 24 one-way transportation trips per year are all available with no copay. Additionally, skilled nursing facility stays require no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Value Plus H5216-179 (PPO) partially covers inpatient hospital services with a $210 daily copay for days 1 to 4, no copay for days 5 to 90, and no coinsurance, though prior authorization is required. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Value Plus H5216-179 (PPO) covers outpatient hospital services with a $0 to $30 copay and 20% coinsurance, and ambulatory surgical center services with a 20% coinsurance and no copay. Additionally, patients pay a $210 copay per stay for observation services and a $30 copay for outpatient substance abuse sessions with no coinsurance for either, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Value Plus H5216-179 (PPO) with a $30.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Value Plus H5216-179 (PPO) offers partially covered ambulance and transportation services, with ground ambulance requiring a $335 copay and no coinsurance, and air ambulance requiring a 20% coinsurance and no copay. Plan-approved transportation is covered for up to 24 one-way trips per year with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Humana Value Plus H5216-179 (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Value Plus H5216-179 (PPO) covers primary care physician services with no copay and no coinsurance. Specialist visits, therapies, chiropractic care, and mental health services are also covered with no coinsurance and copays ranging from $0 to $30, while telehealth benefits have a copay of $0 to $65.
Preventive Services See details
Humana Value Plus H5216-179 (PPO) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, glaucoma screenings, and diabetes self-management. Sub-services not covered under this plan include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Humana Value Plus H5216-179 (PPO) covers hearing exams with a $25 copay and no coinsurance, though routine yearly exams and fitting evaluations have no copay. OTC hearing aids are covered with no copay or coinsurance, while prescription hearing aids are partially covered with no copay or coinsurance, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Humana Value Plus H5216-179 (PPO) covers routine eye exams with no copay (other exams range up to $25) and eyewear with no deductible or coinsurance, subject to prior authorization. Eyewear is partially covered up to a $250 annual limit for contact lenses and complete eyeglasses, but standalone lenses, standalone frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Value Plus H5216-179 (PPO), as fluoride treatments, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered. Medicare-covered dental services require a $25 copay and no coinsurance, while other covered services have no copay and no coinsurance up to a $2,500 annual limit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Value Plus H5216-179 (PPO) and require prior authorization. Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, other Part B drugs have no copay and 0% to 20% coinsurance, and chemotherapy or radiation drugs incur 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Value Plus H5216-179 (PPO) plan with a 20% coinsurance and no copay. Prior authorization is required to access this benefit.
Medical Equipment See details
Humana Value Plus H5216-179 (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are covered with a $10 copay and no coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Humana Value Plus H5216-179 (PPO) covers diagnostic and radiological services with prior authorization, offering lab and outpatient X-ray services with no copay or coinsurance. Other services range from a $0 to $65 copay with no coinsurance for diagnostic tests, a $0 to $335 copay with no coinsurance for diagnostic radiology, and a $25 copay plus 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Humana Value Plus H5216-179 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Humana Value Plus H5216-179 (PPO) where some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered in practice. As these services are not covered, there is no copay or coinsurance coverage available for them.
Skilled Nursing Facility (SNF) See details
Humana Value Plus H5216-179 (PPO) partially covers Skilled Nursing Facility (SNF) benefits, as additional days beyond the Medicare-covered limit are not covered. Covered services require no coinsurance, with no copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Other Services are partially covered by Humana Value Plus H5216-179 (PPO), offering acupuncture limited to 20 treatments yearly, over-the-counter items, and meal benefits for chronic illnesses with no copay or coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
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