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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 2025, 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 2025.
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 $30.90. 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 has a $200.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $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) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, and the monthly premium for Part D is $30.90 with the subsidy.
Additional Benefits
The Humana Value Plus H5216-180 (PPO) plan offers a variety of additional benefits. The plan offers no copay for many services including primary care, preventive services, vision eyewear, dental services, home health services, and more. The plan includes copays for inpatient hospital stays, outpatient services, mental health services, ambulance services, emergency services, and other services. The plan also covers hearing exams, prescription hearing aids, and a maximum of $2,000 per year for dental services.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Humana Value Plus H5216-180 (PPO) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $155 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $180, Observation Services with a $155 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $25 and $40 for both individual and group sessions, and Outpatient Blood Services with no copay. This plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Value Plus H5216-180 (PPO) plan, and requires prior authorization. You will pay a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Value Plus H5216-180 (PPO) plan. Ground ambulance services have a copay of $315, while air ambulance services have a 20% coinsurance, and 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 by the Humana Value Plus H5216-180 (PPO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $40 copay. Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Value Plus H5216-180 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $20 copay, mental health specialty services with a $25 copay for individual and group sessions, podiatry services with a $20 copay, other health care professional services with a copay between $0 and $20, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a copay between $25 and $40. This plan also covers routine chiropractic care with no copay, up to 12 visits per year.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional services that require prior authorization. Additional services include coverage for wigs for hair loss related to chemotherapy, In-Home Support Services, and Fitness benefits, all with no copay. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay.
Hearing Services See details
The Humana Value Plus H5216-180 (PPO) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Value Plus H5216-180 (PPO) plan covers vision services, including eye exams with a copay of $0-$20 and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a maximum benefit of $2,000 per year. 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 oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Value Plus H5216-180 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 15% coinsurance and no copay, Prosthetics/Medical Supplies with no copay, and Diabetic Equipment. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $80, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, Therapeutic Radiological Services have a copay of between $20 and $40, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Value Plus H5216-180 (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 by the Humana Value Plus H5216-180 (PPO) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Value Plus H5216-180 (PPO) plan, with a copay of $10 for days 1-20, and a copay of $214 for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Value Plus H5216-180 (PPO) plan covers acupuncture with no copay, and a limit of 20 treatments per year. The plan also covers a meal benefit with no copay. Other services like over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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