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HumanaChoice H5216-231 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-231 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-231 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-231 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Arkansas. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-231 (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 H5216-231 (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 H5216-231 (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 $285.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $420.00 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 $4500.00 (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 $4500.00 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 H5216-231 (PPO) Medicare plan features an Enhanced Alternative drug benefit with a $420 annual prescription drug deductible. Once you meet this deductible, you will pay a $9 copay for Tier 1 preferred generics at standard pharmacies and preferred mail, or a $47 copay for Tier 2 standard generics. Tier 3 preferred brands and Tier 4 non-preferred drugs require a 46% and 28% coinsurance respectively. For individuals who qualify for the low-income subsidy, this plan offers no copay for Part D coverage. After your total yearly out-of-pocket drug costs reach $2,100, you will enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs. This plan provides clear cost-sharing phases to help you manage your annual medication expenses.
Additional Benefits
The HumanaChoice H5216-231 (PPO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, routine preventive services, and home health care. For inpatient hospital stays, members pay a $295 copay per day for the first six days and no copay for days 7 through 90, while outpatient hospital services range from no copay up to a $375 copay. Specialist visits and mental health services are also affordable, requiring copays between $15 and $35 with no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $1,500 annual limit with no copay for most diagnostic and preventive care. Routine vision and hearing exams are available with no copay, alongside a $200 annual eyewear limit and coverage for prescription hearing aids with a copay. While emergency services are covered with a $130 copay, certain services such as cardiac rehabilitation, transportation, and over-the-counter items are not covered.
Inpatient Hospital See details
HumanaChoice H5216-231 (PPO) partially covers inpatient hospital services with a $295 copay for days 1 to 6, no copay for days 7 to 90, and no coinsurance. While unlimited additional acute hospital days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-231 (PPO) covers outpatient services with no coinsurance, though copays vary depending on the service. You will pay no copay for ambulatory surgical center and blood services, $30 to $35 for outpatient substance abuse sessions, $295 per stay for observation services, and a copay of $0 to $375 for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by HumanaChoice H5216-231 (PPO) with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-231 (PPO) partially covers ambulance and transportation services, offering coverage for ground and air ambulance services with a $335 copay and no coinsurance per service, subject to prior authorization. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-231 (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 H5216-231 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, mental health, and therapy services have copays ranging from $15 to $35 with no coinsurance. The benefit is partially covered, as podiatry services and routine chiropractic care are not covered. Additional telehealth services are also available with copays from $0 to $50 and no coinsurance.
Preventive Services See details
HumanaChoice H5216-231 (PPO) partially covers preventive services with no copay and no coinsurance for covered benefits, which include annual physical exams, memory fitness, kidney disease education, and glaucoma screenings. However, several supplemental services, such as health education, weight management programs, and in-home support services, are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice H5216-231 (PPO), including annual routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $35 copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $699 to $999 and no coinsurance for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-231 (PPO) partially covers vision services with no deductibles and no coinsurance, though prior authorization is required. Routine eye exams have no copay, other eye exams require a copay of up to $35, and covered eyewear has no copay up to a $200 annual limit. Separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-231 (PPO) partially covers dental services up to a combined annual limit of $1,500, with no copay or coinsurance for most diagnostic, preventive, and restorative care. Medicare-covered dental services require a $35 copay, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-231 (PPO) covers home infusion bundled services, requiring prior authorization and offering chemotherapy, radiation, and other Part B drugs with no copay and no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-231 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment benefits are covered by HumanaChoice H5216-231 (PPO), generally requiring prior authorization. Durable medical equipment and prosthetics or medical supplies incur a 20% coinsurance (with no copay for DME), while diabetic supplies require a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts carry a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-231 (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and no coinsurance. Diagnostic tests require a $0 to $100 copay with no coinsurance, diagnostic radiology carries a copay of up to $360 with no coinsurance, and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
HumanaChoice H5216-231 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under HumanaChoice H5216-231 (PPO), as none of the individual sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered by the plan.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-231 (PPO) partially covers Skilled Nursing Facility (SNF) services, though additional days beyond the Medicare-covered limit are not covered. Covered stays require a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100, with no coinsurance.
Other Services See details
HumanaChoice H5216-231 (PPO) partially covers Other Services, as Over-the-Counter (OTC) items and Dual Eligible SNPs with Highly Integrated Services are not covered. Covered benefits include acupuncture, which requires a $35 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits, which are offered with no copay and no coinsurance.
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