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HumanaChoice H5216-251 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-251 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-251 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-251 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Illinois. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-251 (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 H5216-251 (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 H5216-251 (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 $350.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 $6300.00 (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 $6300.00 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 H5216-251 (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order services. Tier 2 generic medications cost $10 for a one-month supply at standard pharmacies, but you can get a three-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with three-month supplies costing $131 through preferred mail order and $141 at standard locations. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 50% coinsurance across all pharmacy options. Tier 5 specialty tier drugs carry a 25% coinsurance for a one-month supply through standard pharmacies and mail order options.
Additional Benefits
The HumanaChoice H5216-251 (PPO) plan offers robust coverage with many essential services requiring no copay or coinsurance, including primary care visits, preventive care, routine hearing exams, and home health services. For specialized medical care, members will pay predictable copays, such as $25 for specialist visits, $150 for emergency room care, and $35 for partial hospitalization, all with no coinsurance. Dental and vision benefits are also highly accessible, featuring no copays for preventive dental care up to a $3,000 annual limit and no copays for covered eyewear up to $250. For more intensive treatments, the plan utilizes structured copays and coinsurance to manage out-of-pocket costs. Inpatient hospital stays require a daily copay of $395 for the first seven days of acute care, while skilled nursing facility care costs $20 per day for days 1 through 20. Additionally, major services like durable medical equipment, dialysis, and therapeutic radiological services are subject to a 20% coinsurance with no copay.
Inpatient Hospital See details
HumanaChoice H5216-251 (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $395 daily copay for days 1 through 7 of acute care and a $360 daily copay for days 1 through 7 of psychiatric care, with no copay for subsequent covered days. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-251 (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital visits have a copay ranging from no copay to $300, observation services carry a $395 copay per stay, and outpatient substance abuse sessions require a $20 to $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-251 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-251 (PPO) covers ambulance services with a $335 copay for ground transport and 20% coinsurance for air transport, both of which require prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-251 (PPO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-251 (PPO) primary care benefits include primary care physician services with no copay and no coinsurance, and specialist visits for a $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $40 copay with no coinsurance, while mental health sessions have a $20 copay with no coinsurance; podiatry and chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-251 (PPO) offers preventive services with no copay and no coinsurance for covered care, including annual physicals, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs. However, this benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, 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/bathroom safety modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice H5216-251 (PPO) covers hearing services with no deductible and no coinsurance, offering Medicare-covered exams for a $25 copay, alongside routine exams, fittings, and over-the-counter hearing aids at no copay. Prescription hearing aids are partially covered with a $699 to $999 copay for up to two aids per year, excluding inner ear, outer ear, and over-the-ear types.
Vision Services See details
HumanaChoice H5216-251 (PPO) provides partially covered vision services with no deductible, no coinsurance, a $0 to $25 copay for eye exams, and no copay for covered eyewear up to a $250 annual limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-251 (PPO) covers dental services up to a $3,000 annual maximum, offering most preventive and comprehensive services with no copay and no coinsurance. However, prosthodontics require a 30% coinsurance with no copay, Medicare-covered dental has a $25 copay with no coinsurance, and fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5216-251 (PPO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-251 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-251 (PPO) covers medical equipment, including durable medical equipment, 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, with prior authorization required for most benefits.
Diagnostic and Radiological Services See details
HumanaChoice H5216-251 (PPO) covers diagnostic and radiological services with no copay and no coinsurance for lab, diagnostic radiological, and outpatient X-ray services. Diagnostic procedures and tests require a copay of $0 to $95 with no coinsurance, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-251 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-251 (PPO) technically covers some Cardiac Rehabilitation Services with no coinsurance, but in practice, cardiac rehabilitation ($25 copay), intensive cardiac rehabilitation ($25 copay), pulmonary rehabilitation ($20 copay), and supervised exercise therapy for PAD ($30 copay) are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-251 (PPO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
HumanaChoice H5216-251 (PPO) covers other services including acupuncture with a $25 copay and no coinsurance for up to 20 treatments per year, requiring prior authorization. Additionally, over-the-counter (OTC) items and meal benefits for chronic illnesses are covered with no copay and no coinsurance, though meal benefits require prior authorization.
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