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HumanaChoice H5216-269 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-269 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-269 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-269 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Alabama. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-269 (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 H5216-269 (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 H5216-269 (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 $450.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 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 $6200.00 (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 $6200.00 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 H5216-269 (PPO) plan has an Enhanced Alternative drug benefit. The plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at preferred mail order pharmacies and standard pharmacies.
Additional Benefits
The HumanaChoice H5216-269 (PPO) plan offers a range of benefits with varying costs. You can expect no copay for primary care, preventive services including an annual physical, and many other services like outpatient blood services, lab services, and home health services. Inpatient hospital stays have a copay of $275, while emergency services cost $140. Other services like specialist visits, hearing exams, and dental services have a copay between $20-$30. The plan also covers hearing aids, vision, and dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay ranging from $0 to $350, observation services with a $275 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $30 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-269 (PPO) plan, with a $30 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice H5216-269 (PPO), including ground ambulance services with a $315 copay, and air ambulance services with 20% coinsurance. 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 H5216-269 (PPO) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $60 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
HumanaChoice H5216-269 (PPO) covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $30 copay, and mental health specialty services with a $30 copay for individual or group sessions. The plan also covers physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $60, and opioid treatment program services with a $30 copay. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5216-269 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay. However, other services like health education and home safety assessments are not covered.
Hearing Services See details
HumanaChoice H5216-269 (PPO) covers hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $699, and OTC hearing aids are covered up to $60 every three months.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$30, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-269 (PPO) plan covers Medicare Dental Services with a $30 copay. Other covered dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-269 (PPO) plan, with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 10% coinsurance and Prosthetics/Medical Supplies with a 10% coinsurance, as well as Diabetic Equipment, which may have coinsurance and copays. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $5 copay.
Diagnostic and Radiological Services See details
The HumanaChoice H5216-269 (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $60, and lab services with no copay. Diagnostic radiological services have a maximum copay of $325, while therapeutic radiological services have a maximum copay of $30 and 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 H5216-269 (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
HumanaChoice H5216-269 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for any covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-269 (PPO) plan, but require prior authorization. For days 1-20, there is a $20 copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $30 copay, while the OTC benefit provides up to $60 every three months, and the meal benefit has no copay.
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