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HumanaChoice H5216-203 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-203 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-203 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-203 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Georgia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-203 (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 H5216-203 (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 H5216-203 (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.
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 $350.00 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 $13900.00 (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 $13900.00 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 H5216-203 (PPO) plan features a $350 annual drug deductible. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies, but they feature no copay for a 3-month supply when ordered through preferred mail. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, while 3-month supplies range from $131 to $141 depending on your pharmacy choice. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 47% coinsurance, and Tier 5 specialty drugs require a 29% coinsurance.
Additional Benefits
The HumanaChoice H5216-203 (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialized care, members pay a $20 copay for specialist visits, a $35 copay for partial hospitalization, and a $375 daily copay for the first several days of inpatient hospital stays. Emergency services and urgently needed care are also covered with no coinsurance, featuring a $115 copay and a $40 copay respectively. This plan also features supplemental benefits, including routine dental care with no copay up to a $1,500 annual limit and routine vision and hearing exams with no copay or coinsurance. Prescription hearing aids are covered with copays ranging from $699 to $999, while covered eyewear is available with no copay up to a $150 annual limit. Additionally, diagnostic lab services and outpatient X-rays carry no copay, while durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5216-203 (PPO) covers inpatient hospital care with no coinsurance, though prior authorization is required. Acute care requires a $375 daily copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric stays require a $375 daily copay for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
HumanaChoice H5216-203 (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $450, observation services carry a $375 copay per stay, and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-203 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the HumanaChoice H5216-203 (PPO) plan, which features a $335 copayment and no coinsurance for both ground and air ambulance services, subject to prior authorization. However, transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-203 (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-203 (PPO) primary care benefits include primary care physician services with no copay and no coinsurance, and specialist visits for a $20 copay and no coinsurance. Physical, occupational, and speech therapy require a $25 copay with no coinsurance, telehealth services range from a $0 to $40 copay with no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-203 (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management, with no copay and no coinsurance. Additional preventive services are only partially covered; while a memory fitness benefit is included with no copay or coinsurance, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, 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, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-203 (PPO) hearing services include Medicare-covered exams for a $20 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 copay of $699 to $999 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-203 (PPO) vision services are partially covered, offering routine eye exams and select eyewear with no deductible and no coinsurance, though other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered. Covered eye exams have a $0 to $20 copay up to a $75 annual limit, while covered contact lenses and eyeglasses have no copay up to a $150 annual limit, with no coinsurance for either service.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-203 (PPO) with a $1,500 annual maximum benefit for both in-network and out-of-network care. Medicare-covered dental services require a $20 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5216-203 (PPO) with no copay, though prior authorization and step therapy apply. Covered Medicare Part B chemotherapy and other drugs require no copay and between no coinsurance and 20% coinsurance, while covered insulin requires a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-203 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-203 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts carry a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-203 (PPO) covers diagnostic and radiological services, featuring no copay for lab services and outpatient X-rays, and a $0 to $120 copay with no coinsurance for diagnostic procedures. Diagnostic radiological services start at a $0 copay, while therapeutic radiological services require a minimum $25 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-203 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-203 (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, although standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-203 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-203 (PPO) partially covers other services, offering acupuncture with a $20 copay and no coinsurance for up to 20 treatments per year, alongside a meal benefit with no copay and no coinsurance, both requiring prior authorization. Over-the-counter (OTC) items are not covered under this plan.
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