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Humana Value Plus H5216-195 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5216-195 (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 H5216-195 (PPO) in 2026, please refer to our full plan details page.
Humana Value Plus H5216-195 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Plus H5216-195 (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 H5216-195 (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 H5216-195 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $10800.00 (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 $10800.00 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 H5216-195 (PPO) prescription drug coverage includes an annual drug deductible of $615. You must pay this deductible amount out-of-pocket for your covered medications before the plan begins to cover its share of your prescription costs. Knowing this deductible is essential for calculating your total out-of-pocket expenses under this Medicare Advantage plan. Since specific drug coverage tier details, copays, and coinsurance rates are not available, you should verify how your specific medications are categorized on the plan's formulary. Comparing your current prescription needs against the $615 deductible will help you decide if the Humana Value Plus H5216-195 (PPO) is the right choice for your healthcare budget.
Additional Benefits
The Humana Value Plus H5216-195 (PPO) plan offers comprehensive coverage with no copay for primary care visits, routine vision exams, routine hearing tests, and home health services. For inpatient hospital stays, you will pay a $325 daily copay for the first six days, followed by no copay for additional days, while emergency room visits carry a $115 copay. This plan also features strong supplemental benefits, including a $1,750 annual limit for dental care and a $350 annual allowance for eyewear with no copay. For specialized services, prescription hearing aids are covered with no copay for up to two devices every three years, and acupuncture is available for a $35 copay. When obtaining durable medical equipment or dialysis, you will pay no copay and instead face coinsurance rates of 15% and 20% respectively. This plan is designed to minimize your out-of-pocket costs for routine wellness while providing clear, predictable cost-sharing for major medical events.
Inpatient Hospital See details
Humana Value Plus H5216-195 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered at no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Value Plus H5216-195 (PPO) covers outpatient services, offering ambulatory surgical center and blood services with no copay and no coinsurance. Outpatient hospital services require a $0 to $325 copay and 20% coinsurance, while outpatient substance abuse sessions have a $25 to $35 copay and no coinsurance, with prior authorization required.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Value Plus H5216-195 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Value Plus H5216-195 (PPO) covers ambulance services with no coinsurance, requiring a $335 copay for ground transport and a $1,250 copay for air transport, with prior authorization required. Routine transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Humana Value Plus H5216-195 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Value Plus H5216-195 (PPO) covers primary care physician services and routine chiropractic care with no copay and no coinsurance, though other chiropractic services are not covered. Other services like specialists, mental health, and physical therapy are covered with copays ranging from $0 to $40 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by the Humana Value Plus H5216-195 (PPO) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, screenings, and memory fitness. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, adult day health, palliative care, and counseling.
Hearing Services See details
Humana Value Plus H5216-195 (PPO) covers Medicare-covered hearing exams with a $35 copay and no coinsurance, while routine annual exams and fitting evaluations are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two aids every three years, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Value Plus H5216-195 (PPO), offering routine eye exams with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $350 annual limit for eyeglasses or contact lenses, but individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Value Plus H5216-195 (PPO) offers partially covered dental services with a $1,750 annual maximum benefit for both in-network and out-of-network care. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered dental services have no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Value Plus H5216-195 (PPO) covers home infusion bundled services, subject to prior authorization and step therapy. Medicare Part B insulin requires a $35 copay and up to 20% coinsurance, while other Part B drugs have up to 20% coinsurance and no copay for non-chemotherapy drugs.
Dialysis Services See details
Humana Value Plus H5216-195 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical equipment is covered by Humana Value Plus H5216-195 (PPO), featuring durable medical equipment and medical supplies at a 15% coinsurance and no copay. Prosthetic devices and diabetic supplies are covered with a 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Humana Value Plus H5216-195 (PPO) covers diagnostic and radiological services with prior authorization required. Outpatient lab services and X-rays require no copay but carry coinsurance, while diagnostic procedures and tests have a copay of $0 to $40 and a minimum 20% coinsurance. Diagnostic radiological services feature no copay or coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Humana Value Plus H5216-195 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Humana Value Plus H5216-195 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are all listed as not covered. For these services, pulmonary and SET for PAD rehabilitation require a 20% coinsurance with no copay, while cardiac and intensive cardiac rehab have no copay or coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Value Plus H5216-195 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and the plan does not cover additional SNF days beyond the standard Medicare-covered limit.
Other Services See details
Other Services are partially covered by the Humana Value Plus H5216-195 (PPO) plan, which offers acupuncture for a $35 copay and no coinsurance for up to 20 treatments per year, alongside chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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