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HumanaChoice H5216-193 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-193 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-193 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-193 (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 HumanaChoice H5216-193 (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 H5216-193 (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 H5216-193 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced 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 H5216-193 (PPO) plan has a $300 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you will pay an $8 copay for preferred generic drugs at a standard pharmacy, and 40% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-193 (PPO) plan offers a range of benefits with varying cost-sharing. You can expect no copay for primary care visits, preventive services, home health services, routine hearing exams, and many dental services. However, you will encounter copays for services like inpatient hospital stays, outpatient services, specialist visits, ambulance services, and hearing exams. This plan also includes coverage for vision and dental services, with no copay for eye exams, and a $1,500 maximum benefit per year for other dental services. Other notable benefits include coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility stays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $440 copay for days 1-6 and no copay for days 7-90, while additional days have no copay; Inpatient Hospital Psychiatric has a $440 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a 20% coinsurance and a copay between $0 and $440, observation services with a $440 copay, and ambulatory surgical center services with no copay. Additionally, outpatient substance abuse services have a copay between $45 and $100 for individual and group sessions, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-193 (PPO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The HumanaChoice H5216-193 (PPO) plan covers all ambulance services, including ground and air ambulance services, each with a $315 copay and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the HumanaChoice H5216-193 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, with no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-193 (PPO) plan offers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a copay between $10 and $40. The plan also covers physician specialist services with a $45 copay, mental health specialty services with a $45 copay, and physical therapy and speech-language pathology services with a copay between $10 and $40. Additionally, telehealth benefits have a copay between $0 and $55, and opioid treatment program services have a copay between $45 and $100.
Preventive Services See details
Preventive Services include no copay for annual physical exams, Medicare-covered services, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Additional preventive services are covered with a copay, including memory fitness. Other services like health education, home safety assessments, and counseling are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids are partially covered, with all types of hearing aids having a copay between $699 and $999, while inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with a maximum benefit of $50 every three months.
Vision Services See details
The HumanaChoice H5216-193 (PPO) plan covers vision services, including eye exams with a copay of $0-$45. Eyewear is covered, with contact lenses and eyeglasses (lenses and frames) having no copay, and a combined maximum of $300 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-193 (PPO) covers dental services, including Medicare dental services with a $45 copay, and other dental services with a $1,500 maximum benefit 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, prosthodontics, fixed, and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice H5216-193 (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-193 (PPO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. For DME, you will pay 20% coinsurance, while Diabetic Supplies have no copay and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered, including diagnostic procedures/tests with a copay up to $55 and a coinsurance of at most 20%, lab services with no copay, diagnostic radiological services with a copay up to $615 and a coinsurance of at most 20%, therapeutic radiological services with a coinsurance of at most 20%, and outpatient X-ray services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-193 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-193 (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214, while additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice H5216-193 (PPO) plan covers acupuncture with a $45 copay, and 20 treatments are allowed each year. Over-the-counter items are covered up to $50 every three months, including nicotine replacement therapy and naloxone. This plan also offers a meal benefit with no copay. However, 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.
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