A non-government entity
HumanaChoice H5216-229 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-229 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-229 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-229 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Indiana and Kentucky. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-229 (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 H5216-229 (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 H5216-229 (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 $250.00 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 $9600.00 (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 $9600.00 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:
Sign up for HumanaChoice H5216-229 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5216-229 (PPO) Medicare prescription drug plan features an annual drug deductible of $250. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic medications cost as little as a $5 copay for a 1-month supply, and you pay no copay for a 3-month supply when utilizing preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with savings available on 3-month supplies through preferred mail order for $131. For higher-tier prescriptions, Tier 4 non-preferred drugs have a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance. This plan provides flexible cost-sharing options to help manage your medication expenses at both retail pharmacies and through mail-order delivery.
Additional Benefits
The HumanaChoice H5216-229 (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialized care, members pay a $45 copay for specialist visits, while emergency room visits require a $130 copay that is waived if admitted. Inpatient hospital stays carry a $420 daily copay for the first seven days of acute stays with no copay for subsequent days, and outpatient hospital services range from no copay up to a $450 copay. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,000 annual limit and vision coverage with no copay for routine exams and eyewear up to a $550 limit. Routine hearing exams and over-the-counter hearing aids are available with no copay, while prescription hearing aids require copays between $699 and $999. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5216-229 (PPO) inpatient hospital care is partially covered, featuring no coinsurance but excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $420 copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $420 copay for days 1-5 and no copay for days 6-90, with prior authorization required for both.
Outpatient Services See details
HumanaChoice H5216-229 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $420 copay per stay for observation services. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse services carry a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under HumanaChoice H5216-229 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-229 (PPO) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required and the copay is not waived if admitted. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-229 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-229 (PPO) features primary care physician visits with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Therapy, mental health, and telehealth services are also covered with varying copays and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-229 (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, but sub-services such as health education, weight management, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access, home safety devices, and counseling are not covered.
Hearing Services See details
HumanaChoice H5216-229 (PPO) covers hearing services with no deductible and no coinsurance, offering a $45 copay for Medicare-covered exams, no copay for routine annual exams, and no copay for OTC hearing aids. Prescription hearing aids are partially covered with copays ranging from $699 to $999, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-229 (PPO) vision services are partially covered with no coinsurance and copays ranging from $0 to $45, featuring one routine eye exam and eyewear like contact lenses or eyeglasses for no copay up to a combined $550 annual limit. Other eye exams, individual eyeglass lenses, separate frames, and upgrades are not covered under this plan.
Dental Services See details
HumanaChoice H5216-229 (PPO) offers partially covered dental services with a combined annual maximum of $2,000, though fluoride, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered. Medicare-covered dental requires a $45 copay and no coinsurance, while other covered services have no copay and coinsurance ranging from 0% to 40%.
Home Infusion bundled Services See details
HumanaChoice H5216-229 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the HumanaChoice H5216-229 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Medical equipment is covered under HumanaChoice H5216-229 (PPO), featuring a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay and a 10% to 20% coinsurance, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-229 (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab services, diagnostic radiology, and outpatient X-rays. Diagnostic procedures and tests require a 20% coinsurance with a copay between $0 and $105, while therapeutic radiological services carry a 20% coinsurance and a minimum $40 copay.
Home Health Services See details
HumanaChoice H5216-229 (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 covered by HumanaChoice H5216-229 (PPO) with a $10 copay and no coinsurance, subject to prior authorization. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-229 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5216-229 (PPO), offering acupuncture with a $45 copay and no coinsurance, alongside over-the-counter items and qualifying meal benefits with no copay and no coinsurance. Other miscellaneous services and dual-eligible SNP benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved