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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. 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 $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) Medicare Advantage plan features an annual prescription drug deductible of $350. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications cost a $5 copay for a 1-month supply at standard pharmacies, but you can get a 3-month supply with no copay through preferred mail order. For Tier 3 preferred brand drugs, the copay is $47 for a 1-month supply, with a reduced copay of $131 for a 3-month supply when filled via preferred mail order. Tier 4 non-preferred drugs require 47% coinsurance across standard pharmacies and mail order services. Lastly, Tier 5 specialty drugs are subject to 29% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H5216-203 (PPO) plan offers affordable access to essential medical care, featuring no copays or coinsurance for primary care visits and preventive services. For specialized care, members pay a $30 copay for specialists, a $115 copay for emergency room visits, and a $335 copay for ambulance services, all with no coinsurance. Inpatient hospital stays require a daily copay of $375 for the first several days and no copay for the remaining days of your stay. This plan also provides comprehensive coverage for everyday wellness, including routine dental, vision, and hearing exams with no copays. Members benefit from a $1,250 annual dental allowance, a $350 annual allowance for glasses or contacts, and low copays on prescription hearing aids. For other services like home health care, there is no copay, while durable medical equipment and dialysis require a 20% coinsurance with no copay.
Inpatient Hospital See details
HumanaChoice H5216-203 (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $375 for days 1 to 7 for acute care and days 1 to 5 for psychiatric care, with no copay for remaining days. While unlimited additional acute days are covered at no copay, additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5216-203 (PPO) with no coinsurance, featuring copays ranging from $0 to $450 for outpatient hospital services and a $375 copay per stay for observation services. Patients will pay no copay and no coinsurance for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-203 (PPO) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HumanaChoice H5216-203 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-203 (PPO) covers emergency services with a $115 copay and no coinsurance, which is 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
HumanaChoice H5216-203 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Other covered services, including physical therapy ($25 copay), mental health sessions ($35 copay), and telehealth ($0 to $40 copay), also feature no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-203 (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive services are partially covered; a memory fitness benefit is included with no copay or coinsurance, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and home-based support services are not covered.
Hearing Services See details
HumanaChoice H5216-203 (PPO) covers hearing exams with a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay between $99 and $399 for up to two aids per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-203 (PPO) partially covers vision services with no coinsurance and copays ranging from no copay up to $30, with no deductible required. Covered benefits include one routine eye exam and a combined $350 annual allowance for contact lenses or eyeglasses (lenses and frames) with no copay, though other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-203 (PPO) partially covers dental services with an annual maximum benefit of $1,250 for both in-network and out-of-network care. Medicare-covered dental services require a $30 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
HumanaChoice H5216-203 (PPO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-203 (PPO) covers dialysis services 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 medical equipment, including durable medical equipment (DME) and prosthetics with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H5216-203 (PPO) covers diagnostic and radiological services, though prior authorization is required. Outpatient lab services and X-rays feature no copay, diagnostic procedures carry a copay of $0 to $120 with no coinsurance, and therapeutic radiological services require a minimum $30 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
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-203 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, carrying copayments ranging from $20 to $30.
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, a prior 3-day hospital stay is not needed, and 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 $30 copay, no coinsurance, and prior authorization for up to 20 treatments annually. Over-the-counter (OTC) items, meal benefits, and dual-eligible SNP services are not covered under this plan.
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