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HumanaChoice H5216-253 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-253 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-253 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-253 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Eastern Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-253 (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 H5216-253 (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 H5216-253 (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 $3.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $10100.00 (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 $10100.00 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 H5216-253 (PPO) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you can expect a $10 copay at preferred mail and standard pharmacies, and a $20 copay at standard mail pharmacies. For standard generic drugs, the copay is $47. Brand name drugs have a 50% coinsurance, and non-preferred drugs have a 30% coinsurance. After your total drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-253 (PPO) plan offers coverage for a wide range of services, including inpatient and outpatient hospital care, with varying copays. This plan also includes coverage for primary care visits with no copay, and specialist visits for a $50 copay. Additionally, it provides benefits for hearing and vision services, with copays for hearing exams and eye exams, and no copay for routine hearing exams, fitting/evaluation for hearing aids, and eyewear. This plan also covers ambulance services, emergency services, and offers dental services with no copay for oral exams, dental x-rays, and other diagnostic services. Home health services are covered with no copay, and there is coverage for over-the-counter items and meals. However, certain services like cardiac rehabilitation services and podiatry are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care, with a copay of $430 per day for days 1-6 and no copay for days 7-90 for acute care, and a copay of $380 per day for days 1-6 and no copay for days 7-90 for psychiatric care. Additional days for inpatient hospital psychiatric are not covered, and upgrades and non-Medicare covered stays for both services are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $450, and observation services with a $430 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $30 and $85 for individual or group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-253 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HumanaChoice H5216-253 (PPO) plan, including both ground and air ambulance services. Ground ambulance services have a copay of $315, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice H5216-253 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-253 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. It also covers physician specialist services with a $50 copay, individual and group mental health and psychiatric sessions with a $50 copay, physical therapy and speech-language pathology services with a $40 copay, and telehealth services with a copay between $0 and $55. The plan does not cover podiatry services, and routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams with no copay, and additional preventive services. Some additional preventive services are covered with no copay, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The HumanaChoice H5216-253 (PPO) plan covers hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with the plan covering Prescription Hearing Aids (all types) with a copay between $699 and $999, but not covering Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, or Prescription Hearing Aids - Over the Ear. OTC hearing aids are also covered, with a maximum benefit of $150 every three months for both ears combined.
Vision Services See details
The HumanaChoice H5216-253 (PPO) plan covers vision services, including eye exams with a copay between $0 and $50, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-253 (PPO) offers dental services including oral exams with no copay, dental x-rays with no copay, and other diagnostic dental services with no copay. Prosthodontics, removable and Prosthodontics, fixed have a 30% coinsurance and no copay, while Fluoride Treatment, Maxillofacial Prosthetics, Implants, 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 0-10% coinsurance, and other Medicare Part B Drugs with 0-10% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs are also covered with 0-10% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-253 (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 5% coinsurance, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items, and Medical Supplies with a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered under this plan, with a copay for Medicare-covered diagnostic procedures/tests and lab services, ranging from $0 to $85. Outpatient X-Ray Services have no copay, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-253 (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H5216-253 (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5216-253 (PPO) plan, with a $10 copay for days 1-20 and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice H5216-253 (PPO) plan covers acupuncture with a $50 copay, and covers over-the-counter items, with a maximum benefit coverage amount of $150 every three months, and a meal benefit with no copay. However, other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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