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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 2026, 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 2026.
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 $0.00. 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 $215.00 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 $6700.00 (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 $6700.00 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 features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and preferred mail order. Tier 2 generic drugs cost $5 for a 1-month supply at standard pharmacies and preferred mail order, and there is no copay for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies, preferred mail order, and standard mail order. Tier 4 non-preferred drugs carry a 48% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty tier drugs require a 25% coinsurance for a 1-month supply across all pharmacy and mail order options.
Additional Benefits
The Humana Full Access H5216-192 (PPO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, routine dental and vision care, and home health services. For specialized medical needs, members pay a $70 copay for specialist visits and a $600 copay per stay for the first few days of inpatient hospital care, with no coinsurance. Emergency care is available with a $130 copay, while urgent care services require a $50 copay. Routine hearing exams feature no copay, and prescription hearing aids are covered with copays ranging from $699 to $999. Skilled nursing facility stays require daily copays of $10 for the first 20 days and $218 for days 21 through 100, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Diagnostic lab and outpatient x-ray services are also available with no copays, though coinsurance may apply.
Inpatient Hospital See details
Humana Full Access H5216-192 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $600 copay for days 1 through 4 for acute stays and days 1 through 3 for psychiatric stays, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Outpatient services are covered by Humana Full Access H5216-192 (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $35 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay ranging from $0 to $670, while outpatient observation services carry a $600 copay per stay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Full Access H5216-192 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Full Access H5216-192 (PPO) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Full Access H5216-192 (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 require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance, with none of these costs subject to a deductible.
Primary Care See details
Humana Full Access H5216-192 (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $70 copay and no coinsurance. Additional covered benefits include physical, occupational, and speech therapies ($10 to $40 copay), mental health and psychiatric services ($35 copay), and telehealth ($0 to $70 copay) with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by the Humana Full Access H5216-192 (PPO) plan with no copay and no coinsurance for annual exams, memory fitness, and chemotherapy wigs up to $500 annually. However, the benefit is partially covered as it excludes health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home/bathroom safety devices, and counseling.
Hearing Services See details
Humana Full Access H5216-192 (PPO) hearing services include Medicare-covered exams for a $70 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two aids per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Full Access H5216-192 (PPO) with no coinsurance, no deductibles, and no copays for routine eye exams, contact lenses, and eyeglasses (lenses and frames). Other eye exam services, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by Humana Full Access H5216-192 (PPO), offering most preventive and comprehensive dental care with no copay and no coinsurance, while Medicare-covered dental services require a $70 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Full Access H5216-192 (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Full Access H5216-192 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Humana Full Access H5216-192 (PPO) covers medical equipment, featuring a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $0 to $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Humana Full Access H5216-192 (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab services, outpatient x-rays, and diagnostic radiology, though coinsurance applies to lab and x-ray services. Diagnostic procedures require a copay of up to $70 with a minimum 20% coinsurance, while therapeutic radiology carries a minimum $50 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Full Access H5216-192 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Full Access H5216-192 (PPO) covers some services under its Cardiac Rehabilitation Services benefit with no coinsurance, though prior authorization is required. However, cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Full Access H5216-192 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, no prior three-day inpatient hospital stay is needed, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Humana Full Access H5216-192 (PPO) offers partial coverage for other services, including acupuncture with a $70.00 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Both covered benefits require prior authorization, while over-the-counter (OTC) items are not covered under this plan.
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