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HumanaChoice H5216-188 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-188 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-188 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-188 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Southern Indiana and Kentucky. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-188 (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 HumanaChoice H5216-188 (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 HumanaChoice H5216-188 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.00. 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 $300.00 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 $10100.00 (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 $10100.00 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 HumanaChoice H5216-188 (PPO) prescription drug plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, you will pay no copay for 1-month or 3-month supplies at standard pharmacies and preferred mail-order services. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a 1-month supply or no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, though you can save on a 3-month supply by using preferred mail order for $131. For more advanced medications, Tier 4 non-preferred drugs carry a 50% coinsurance across all pharmacy options. Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply, helping you plan your healthcare costs effectively with this Medicare PPO plan.
Additional Benefits
The HumanaChoice H5216-188 (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care doctor visits, preventive care services, and home health care. Specialist visits require a $45 copay, while inpatient hospital stays require a $330 daily copay for the first few days and no copay for subsequent days. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care is available with a $50 copay. For routine wellness, the plan provides routine eye exams, hearing exams, and preventive dental care with no copay, alongside a generous $3,500 maximum annual dental benefit. Skilled nursing facility stays feature no copay for the first 20 days, while durable medical equipment and dialysis services generally require a 20% coinsurance. This plan is designed to keep healthcare affordable by offering no copays on essential routine services and predictable flat copayments for specialized care.
Inpatient Hospital See details
HumanaChoice H5216-188 (PPO) covers inpatient hospital care with no coinsurance, requiring a $330 daily copay for days 1-8 for acute stays (with no copay for days 9 and beyond) and a $330 daily copay for days 1-6 for psychiatric stays (with no copay for days 7-90). Prior authorization is required, and hospital upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-188 (PPO) outpatient services are covered with no coinsurance, including ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services carry a copay of $0 to $330, observation services require a $330 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-188 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance, subject to prior authorization requirements.
Ambulance and Transportation Services See details
HumanaChoice H5216-188 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-188 (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 for a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-188 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Therapy and mental health services require copays between $20 and $35 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-188 (PPO) provides preventive services with no copay and no coinsurance, covering annual physical exams, memory fitness, kidney disease education, and Medicare-covered screenings. This benefit is partially covered, as sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, weight management, alternative therapies, and home-based palliative care are not covered.
Hearing Services See details
Hearing services covered by HumanaChoice H5216-188 (PPO) include routine hearing exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $499 and $799 for up to two aids per year, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter (OTC) hearing aids are also covered with no copay or coinsurance, and there is no deductible for any hearing services.
Vision Services See details
HumanaChoice H5216-188 (PPO) partially covers vision services with no coinsurance or deductibles, offering eye exams with a $0 to $45 copay (no copay for routine annual exams) and eyewear with no copay. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered by the plan.
Dental Services See details
HumanaChoice H5216-188 (PPO) provides partially covered dental services with a $3,500 annual maximum benefit for both in- and out-of-network care. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-188 (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HumanaChoice H5216-188 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-188 (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
Diagnostic and radiological services are covered by HumanaChoice H5216-188 (PPO) with prior authorization required. Diagnostic procedures and lab services have no coinsurance, with copays ranging from no copay up to $105, while radiological services range from no copay for X-rays to a minimum 20% coinsurance and $45 copay for therapeutic treatments.
Home Health Services See details
HumanaChoice H5216-188 (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-188 (PPO) offers Cardiac Rehabilitation Services with no coinsurance and a $10 copay, subject to prior authorization. Although some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by HumanaChoice H5216-188 (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 a prior three-day hospital stay is not needed, but additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-188 (PPO) partially covers other services, offering acupuncture for a $45 copay and no coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Other miscellaneous services and highly integrated dual-eligible SNP benefits are not covered under this plan.
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