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Humana Full Access H5216-192 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-192 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5216-192 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access H5216-192 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Full Access H5216-192 (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 Full Access H5216-192 (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 Full Access H5216-192 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $2.00. 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 has a $575.00 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 $6500.00 (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 $6500.00 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 Full Access H5216-192 (PPO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, for preferred generic drugs at a standard pharmacy, you will pay an $8 copay, and for preferred brand drugs, you will pay 48% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Full Access H5216-192 (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency services, including worldwide coverage, have copays. Primary care visits have no copay, while specialist visits and some therapies have copays. Vision and dental services are also covered, with routine eye exams and preventive dental care having no copay. The plan provides additional benefits such as hearing exams and hearing aids, with copays. Medical equipment, home health, and dialysis services are covered with coinsurance or copays. The plan also covers ambulance services and cardiac rehabilitation, along with other services like acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $600 for days 1-4, and no copay for days 5-90 for Inpatient Hospital-Acute, and a copay of $600 for days 1-3, and no copay for days 4-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Humana Full Access H5216-192 (PPO) plan. Outpatient hospital services have a copay between $0 and $670, observation services have a $600 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay between $60 and $90, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Full Access H5216-192 (PPO) plan, with a $50 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Full Access H5216-192 (PPO) plan. Ground and Air Ambulance Services have a $315 copay, but there is no coinsurance; however, Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Humana Full Access H5216-192 (PPO). Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, and no coinsurance.
Primary Care See details
The Humana Full Access H5216-192 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a copay between $10 and $40. The plan also covers physician specialist services with a $70 copay, mental health and psychiatric individual and group sessions with a $60 copay, physical therapy and speech-language pathology services with a copay between $10 and $40, additional telehealth benefits with a copay between $0 and $70, and opioid treatment program services with a copay between $60 and $90. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Full Access H5216-192 (PPO) plan covers preventive services, including an annual physical exam with no copay. Other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Humana Full Access H5216-192 (PPO) plan covers hearing exams with a $70 copay, and routine hearing exams with no copay for 1 visit per year. Fitting/Evaluation for Hearing Aids has no copay. Prescription Hearing Aids (all types) are covered with a copay between $699 and $999 for 2 visits per year, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are also not covered.
Vision Services See details
The Humana Full Access H5216-192 (PPO) plan covers vision services, including routine eye exams with a copay between $0 and $70 and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Full Access H5216-192 (PPO) plan covers a variety of dental services. Medicare dental services have a $70 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have 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, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Full Access H5216-192 (PPO) plan and require prior authorization. The coinsurance for this service is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, and medical supplies, are covered under the Humana Full Access H5216-192 (PPO) plan. Durable Medical Equipment (DME) has a 10% coinsurance, while Prosthetic Devices, and Medical Supplies each have a 10% coinsurance. Diabetic supplies have a 10% to 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 by the Humana Full Access H5216-192 (PPO) plan, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a copay of up to $70 and a coinsurance of at least 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $720, and Therapeutic Radiological Services have a copay of up to $50 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5216-192 (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 Humana Full Access H5216-192 (PPO), but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Humana Full Access H5216-192 (PPO) plan, with a copay of $10 per day for days 1-20, and $214 per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services with Humana Full Access H5216-192 (PPO) includes acupuncture with a $70 copay, and a meal benefit with no copay; however, 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. Acupuncture is limited to 20 treatments per year.
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