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HumanaChoice H5216-207 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-207 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-207 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-207 (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 H5216-207 (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 H5216-207 (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 H5216-207 (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 has a $200.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $9250.00 (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 $9250.00 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 H5216-207 (PPO) Medicare prescription drug plan features an annual drug deductible of $350. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies or preferred mail order, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 48% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply. This plan offers competitive savings on generic medications while providing structured cost-sharing for brand-name and specialty prescriptions.
Additional Benefits
The HumanaChoice H5216-207 (PPO) plan provides comprehensive medical coverage, featuring no copay or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, patients pay a $30 copay, while inpatient hospital stays require a $375 daily copay for the first several days and no copay thereafter. Emergency care is available with a $115 copay, and urgent care costs $40, with no coinsurance required for either service. This plan also includes essential dental, vision, and hearing benefits, offering routine exams with no copay alongside coverage for glasses, contacts, and hearing aids. Diagnostic services like labs and X-rays have no copay, while durable medical equipment and dialysis require a 20% coinsurance. Additionally, members can access over-the-counter items with no copay and acupuncture for a $30 copay.
Inpatient Hospital See details
HumanaChoice H5216-207 (PPO) covers inpatient hospital care with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent covered days. This benefit is partially covered, as hospital upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
HumanaChoice H5216-207 (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most benefits. There is no copay for ambulatory surgical center and blood services, while outpatient hospital services require a copay of $0 to $450, observation services cost a $375 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-207 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-207 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Routine transportation services are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-207 (PPO) emergency services are covered 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
HumanaChoice H5216-207 (PPO) primary care benefits feature no copay and no coinsurance for primary care doctor visits, while specialist services require a $30 copay and no coinsurance. Other covered services like physical therapy and mental health sessions have copays ranging from $25 to $35 with no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice H5216-207 (PPO) with no copay and no coinsurance for services such as annual physical exams, kidney disease education, fitness benefits, and glaucoma screenings. However, the benefit is only partially covered, as excluded sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services covered by the HumanaChoice H5216-207 (PPO) plan include Medicare-covered exams for a $30 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $199 to $499 copay and no coinsurance, excluding inner ear, outer ear, and over the ear models, while OTC hearing aids are covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice H5216-207 (PPO) partially covers vision services with no coinsurance and copays ranging from $0 to $30, with prior authorization required. One routine eye exam per year is covered with no copay up to a $40 limit, and contact lenses or eyeglasses are covered with no copay up to a combined $350 annual limit, but other eye exams, standalone eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-207 (PPO) offers partially covered dental services with a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $1,000 yearly limit. Most preventive and comprehensive services require no copay or coinsurance, but fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-207 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and other drugs, require no copay and carry ranging from no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and ranging from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-207 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-207 (PPO) covers durable medical equipment (DME), 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 or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-207 (PPO) covers diagnostic and radiological services with prior authorization, offering lab services, outpatient X-rays, and diagnostic radiological services with no copay. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $120, while therapeutic radiological services require at least a 20% coinsurance and a $30 copay.
Home Health Services See details
HumanaChoice H5216-207 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HumanaChoice H5216-207 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-207 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior 3-day hospital stay requirement. There is no copay for days 1 to 20 and a $218 daily copay for days 21 to 100, though prior authorization is required and additional days beyond Medicare-covered limits are not covered.
Other Services See details
HumanaChoice H5216-207 (PPO) covers acupuncture with a $30 copay and no coinsurance for up to 20 treatments per year, requiring prior authorization. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance, excluding some CMS OTC list drugs, and chronic illness meal benefits are covered with no copay and no coinsurance.
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