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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 2026, 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 2026.
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) Medicare plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $590.00. For individuals who qualify for the low-income subsidy, the plan features no premium cost. During the initial coverage phase, Tier 1 preferred generics require a $5.00 copay at standard pharmacies and preferred mail, or a $20.00 copay through standard mail. Tier 2 standard generics carry a $47.00 copay, while Tier 3 preferred brands require 47% coinsurance and Tier 4 non-preferred drugs require 26% coinsurance. These copays and coinsurance rates apply until total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs.
Additional Benefits
The HumanaChoice H5216-269 (PPO) plan offers comprehensive medical coverage, including primary care visits and annual physical exams with no copay and no coinsurance. Specialist visits require a $30 copay, while inpatient hospital stays carry a $275 daily copay for the first several days before transitioning to no copay for the rest of your stay. Emergency room services are covered with a $150 copay, which is waived if you are admitted within 24 hours, and urgent care carries a $65 copay. For routine care, the plan features no copay for routine eye and hearing exams, along with a $2,000 annual limit for covered dental services which mostly require no copay. Diagnostic lab services, outpatient X-rays, and home health services are fully covered with no copay or coinsurance. However, specialized needs such as durable medical equipment and dialysis services require a 20% coinsurance, while skilled nursing facility stays are covered with no copay for the first 20 days.
Inpatient Hospital See details
HumanaChoice H5216-269 (PPO) partially covers inpatient hospital care with no coinsurance, featuring a $275 daily copay for days 1 through 7 of acute stays and days 1 through 6 of psychiatric stays, with no copay for remaining covered days. Non-Medicare-covered stays and upgrades for acute care, along with additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
HumanaChoice H5216-269 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services carry a $0 to $350 copay, while patients pay a $275 copay per stay for observation services and a $35 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
HumanaChoice H5216-269 (PPO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-269 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-269 (PPO) with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered under a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits under HumanaChoice H5216-269 (PPO) feature no copay and no coinsurance for primary care visits, while specialist visits require a $30 copay. Physical, occupational, and speech therapies require a $20 copay, whereas podiatry is not covered and chiropractic care is only partially covered with routine care excluded. Mental health, psychiatric, and opioid treatments have a $35 copay, and telehealth services range from no copay to a $65 copay, all with no coinsurance.
Preventive Services See details
Preventive services are covered by HumanaChoice H5216-269 (PPO) with no copay or coinsurance for annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered, offering memory fitness benefits and in-home support with no copay, while sub-services like health education, nutritional therapy, and weight management are not covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-269 (PPO), offering no coinsurance across all covered benefits. Routine exams, fittings, and OTC hearing aids have no copay, while diagnostic exams have a $30 copay and covered prescription hearing aids require a $399 to $699 copay; however, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-269 (PPO) provides partially covered vision services, offering one annual routine eye exam with no copay and covered eyewear with no copay and no coinsurance up to a $250 yearly limit. Other eye exams have a copay of $0 to $30 and no coinsurance up to a $75 annual limit, while separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-269 (PPO) up to a $2,000 annual limit, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Medicare dental services require a $30 copay and no coinsurance, prosthodontics require no copay and 30% coinsurance, and all other covered dental services have no copay and no coinsurance.
Home Infusion bundled Services See details
HumanaChoice H5216-269 (PPO) covers home infusion bundled services with prior authorization required. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-269 (PPO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-269 (PPO) covers durable medical equipment with a 20% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance. Diabetic supplies require a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts have a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-269 (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Lab services and outpatient X-rays have no copay and no coinsurance, diagnostic tests carry a $0 to $65 copay (no coinsurance), diagnostic radiology has a copay up to $335 (no coinsurance), and therapeutic radiology requires up to a $30 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-269 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5216-269 (PPO) plan, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered. Since there is no coverage for these services, no copayments or coinsurance are provided by the plan.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-269 (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. Patients pay no copay and no coinsurance for days 1 through 20, and a $218 copay with no coinsurance for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-269 (PPO) covers acupuncture with a $30 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay or coinsurance. Prior authorization is required for acupuncture and meal benefits, while dual eligible SNP services are not covered.
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