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HumanaChoice H5216-233 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-233 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-233 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-233 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Honolulu, Kauai and Maui counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-233 (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 H5216-233 (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 H5216-233 (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 has a $100.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (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 $10000.00 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 H5216-233 (PPO) plan has an enhanced alternative drug benefit. This plan has a $0 deductible. In the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, but have a $20 copay at standard mail order. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-233 (PPO) plan offers a range of benefits, including inpatient hospital stays with varying copays, and outpatient services with copays ranging from $0 to $350. The plan also covers emergency services, primary care, preventive services, hearing, vision, and dental services, with specific copays for each. Additionally, the plan includes coverage for home health services, dialysis, and medical equipment, with some services requiring prior authorization and/or coinsurance.
Inpatient Hospital See details
Inpatient hospital stays are covered, with a copay of $460 for days 1-5 and no copay for days 6-90 for acute care. Additional days for inpatient hospital-acute are covered with no copay. Inpatient hospital psychiatric stays are also covered, with a copay of $450 for days 1-5 and no copay for days 6-90. Non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
The HumanaChoice H5216-233 (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $350, observation services with a $460 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-233 (PPO) plan, but requires prior authorization. You will have a $100 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a $1250 copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice H5216-233 (PPO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay and no coinsurance.
Primary Care See details
The HumanaChoice H5216-233 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $55 copay, and physical therapy and speech-language pathology services with a $45 copay. Mental health and psychiatric services have a $40 copay, podiatry services and other health care professionals have variable copays, and additional telehealth benefits have a copay between $0 and $55. The plan also covers opioid treatment program services with a $40 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with a copay. Other covered services include Kidney Disease Education Services with no copay, and Other Preventive Services with a copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $55 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay; prescription hearing aids have a copay between $699 and $999, and OTC hearing aids are not covered. Prescription hearing aids for the inner ear, outer ear, and over the ear are also not covered.
Vision Services See details
The HumanaChoice H5216-233 (PPO) plan covers vision services, including eye exams with a copay of $0-$55. Eyewear is covered with no copay, and contact lenses and eyeglasses (lenses and frames) are covered with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-233 (PPO) plan covers Medicare Dental Services with a $55 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-233 (PPO) plan, but require prior authorization. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have a coinsurance of at most 20% and a copay of at most $200.00, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $460.00, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-233 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice H5216-233 (PPO) plan, but are not covered in practice. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5216-233 (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
Under "Other Services," the HumanaChoice H5216-233 (PPO) plan covers acupuncture with a $55 copay, and covers a meal benefit with no copay; however, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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