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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 2025, 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 2025.
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 $33.90. 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 $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 $11300.00 (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 $11300.00 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) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, your Part D premium will be $33.90. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Humana Value Plus H5216-195 (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1725 copay, while outpatient services often involve coinsurance, such as 20% for outpatient hospital services and substance abuse services. Emergency services have a $110 copay, and primary care visits have no copay, but specialist visits have a $50 copay. Preventive services and routine hearing exams have no copay, and vision services include eye exams and eyewear with no copay. Dental services have no copay for many services, with a $1,000 annual maximum. The plan also includes coverage for home health services with no copay, and skilled nursing facility stays with a $0 copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a copay of $1725 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and all Inpatient Hospital Psychiatric additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance and no copay, Observation Services with a $430 copay, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance and no copay, Outpatient Substance Abuse Services with a 20% coinsurance for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Value Plus H5216-195 (PPO) plan, but requires prior authorization. You will pay 20% coinsurance for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Value Plus H5216-195 (PPO) plan. Ground Ambulance Services have a 20% coinsurance, while Air Ambulance Services have a $1250 copay. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a 20% coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $110 copay.
Primary Care See details
The Humana Value Plus H5216-195 (PPO) plan covers primary care physician services with no copay. Chiropractic services are covered with 20% coinsurance, and routine chiropractic care has no copay for up to 12 visits per year. Specialist visits have a $50 copay. Physical therapy and speech-language pathology services have a $30 copay, and telehealth benefits have 20% coinsurance with a copay between $0 and $50. Individual and group mental health and psychiatric sessions have 20% coinsurance, as do opioid treatment program services. Podiatry services are covered with a $50 copay for Medicare-covered services and routine foot care.
Preventive Services See details
The Humana Value Plus H5216-195 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered with varying copays.
Hearing Services See details
The Humana Value Plus H5216-195 (PPO) plan covers hearing exams with a $50 copay, and routine hearing exams with no copay for one visit every year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Value Plus H5216-195 (PPO) plan covers vision services, including eye exams with a copay between $0 and $50. Eyewear, including contact lenses and eyeglasses, is covered with a $0 copay, up to a combined maximum of $300 every year.
Dental Services See details
Dental services include a $50 copay for Medicare dental services, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery have no copay. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. This plan has a maximum benefit of $1,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%, but there is no copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Value Plus H5216-195 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Humana Value Plus H5216-195 (PPO) plan covers Durable Medical Equipment (DME) with a 10% coinsurance and no copay, as well as Prosthetics/Medical Supplies and Diabetic Equipment. Prosthetic Devices and Medical Supplies have 20% coinsurance, while Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Value Plus H5216-195 (PPO) plan. Diagnostic Procedures/Tests have a coinsurance of up to 20% and a copay of up to $50, while Lab Services have a coinsurance of up to 20% and no copay. Diagnostic Radiological Services have a coinsurance of up to 20% and a copay of up to $325, and Therapeutic Radiological Services have a coinsurance of up to 20%. Outpatient X-Ray Services have a coinsurance of up to 20% and no copay.
Home Health Services See details
Home Health Services are covered by the Humana Value Plus H5216-195 (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 not covered by the Humana Value Plus H5216-195 (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Value Plus H5216-195 (PPO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Value Plus H5216-195 (PPO) plan covers acupuncture with a $50 copay for up to 20 treatments per year, and a meal benefit with no copay. Other services such as over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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