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Humana Value Plus H5216-180 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5216-180 (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 H5216-180 (PPO) in 2026, please refer to our full plan details page.
Humana Value Plus H5216-180 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Tennessee. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Plus H5216-180 (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 H5216-180 (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 H5216-180 (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 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 $7000.00 (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 $7000.00 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 H5216-180 (PPO) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before your plan coverage kicks in. Specific drug tier coverage details, including copays and coinsurance rates, are not available for this plan. To estimate your actual prescription costs, you will need to verify how your specific medications are positioned on the plan's formulary.
Additional Benefits
The Humana Value Plus H5216-180 (PPO) plan provides affordable healthcare coverage with no copay and no coinsurance for primary care doctor visits, routine preventive services, and home health care. If you require inpatient hospital care, you will pay a $155 daily copay for days one through five, followed by no copay for days six through 90. Specialist visits and therapy services carry a $20 copay, while emergency care has a $130 copay which is waived upon hospital admission. For extra benefits, this plan covers routine dental services up to a $2,000 annual limit, routine vision exams, and eyewear with no copay or coinsurance. Members also benefit from up to 36 one-way transportation trips to approved locations and acupuncture treatments at no copay. Standard medical equipment, such as prosthetics and durable medical equipment, is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Value Plus H5216-180 (PPO) covers inpatient hospital services with no coinsurance, requiring a $155 copay per day for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Value Plus H5216-180 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $180 copay for outpatient hospital services, a $155 copay per stay for observation services, and a $25 to $35 copay for substance abuse sessions. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, though prior authorization is required for most of these outpatient services.
Partial Hospitalization See details
Humana Value Plus H5216-180 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Humana Value Plus H5216-180 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Value Plus H5216-180 (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 are available with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Value Plus H5216-180 (PPO) provides primary care physician services with no copay and no coinsurance, while specialist, occupational, physical, and speech therapy services require a $20 copay and no coinsurance. Chiropractic care is partially covered, offering up to 12 routine visits per year with no copay and no coinsurance, though other chiropractic services are not covered. Mental health, psychiatric, podiatry, telehealth, and opioid treatment services are also covered with copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
Humana Value Plus H5216-180 (PPO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. While some additional supplemental services like memory fitness, in-home support, and chemotherapy wigs (up to $500 annually) are covered at no cost, several other benefits—such as health education, weight management, and nutritional therapy—are not covered.
Hearing Services See details
Humana Value Plus H5216-180 (PPO) covers hearing services, offering Medicare-covered exams for a $20 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 or coinsurance for up to two devices every three years, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Value Plus H5216-180 (PPO) partially covers vision services with no deductible, offering eye exams with a $0 to $20 copay and no coinsurance, and eyewear with no copay or coinsurance. Routine eye exams and eyeglasses (lenses and frames) are covered, but other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Value Plus H5216-180 (PPO) partially covers dental services with a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,000 annual limit. Specific services that are not covered under this plan include fluoride treatments, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Value Plus H5216-180 (PPO) plan, with prior authorization required and step therapy applying from Part B to Part D. Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, other Part B drugs feature 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 H5216-180 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Value Plus H5216-180 (PPO) covers durable medical equipment, medical supplies, prosthetics, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are covered with a $10 copay, and prior authorization is required for most medical equipment and supplies.
Diagnostic and Radiological Services See details
Humana Value Plus H5216-180 (PPO) covers diagnostic and radiological services, offering lab services, outpatient X-rays, and diagnostic radiology with no copay. Diagnostic procedures and tests have no coinsurance and a copay of up to $80, while therapeutic radiological services require a minimum 20% coinsurance and a $20 copay.
Home Health Services See details
Humana Value Plus H5216-180 (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Humana Value Plus H5216-180 (PPO) provides no coinsurance for Cardiac Rehabilitation Services, meaning some services are covered, although prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this plan and require a $20 copay.
Skilled Nursing Facility (SNF) See details
Humana Value Plus H5216-180 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Humana Value Plus H5216-180 (PPO), offering acupuncture (up to 20 treatments annually), over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while other unspecified supplemental services are not covered.
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