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HumanaChoice H5216-271 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-271 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-271 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-271 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Southwest Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-271 (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 H5216-271 (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 H5216-271 (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 $165.00 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 $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 H5216-271 (PPO) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, your costs will vary depending on the drug tier and where you fill your prescription. For example, in the initial coverage phase, you can expect to pay a $10 copay for preferred generic drugs at preferred or mail order pharmacies, and a $20 copay at a standard pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-271 (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays, as well as coverage for ambulance and emergency services. The plan also includes no-copay coverage for primary care, preventive services, and home health services, alongside benefits for hearing, vision, and dental services, with some cost-sharing through copays or coinsurance. Additionally, the plan provides coverage for medical equipment, diagnostic services, and other services like acupuncture and OTC items, while excluding certain services such as cardiac rehabilitation and additional hours of home care.
Inpatient Hospital See details
Inpatient Hospital services are covered by the HumanaChoice H5216-271 (PPO) plan. For Inpatient Hospital-Acute, you pay a copay of $299 for days 1-8, and no copay for days 9-90, and for Inpatient Hospital Psychiatric, you pay a copay of $272 for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services, offered by HumanaChoice H5216-271 (PPO), covers outpatient hospital services with a copay between $0 and $300, observation services with a $299 copay, and ambulatory surgical center services with no copay. Individual and group sessions for outpatient substance abuse have a copay of $30, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-271 (PPO) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The HumanaChoice H5216-271 (PPO) plan covers ambulance services, with a $315 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services, urgently needed services, and worldwide emergency services are covered. Emergency services have a $125 copay, and urgently needed services have a $55 copay, with no coinsurance for either. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation all have a $125 copay, with no coinsurance.
Primary Care See details
HumanaChoice H5216-271 (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 and group sessions. This plan also covers physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $30 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, as well as additional preventive services and kidney disease education services, with a $0 copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following the Welcome Visit. 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
HumanaChoice H5216-271 (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 are partially covered, with a copay between $99 and $699 for all types, while inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered with a maximum benefit of $100 every three months.
Vision Services See details
The HumanaChoice H5216-271 (PPO) plan covers vision services, including eye exams with a copay of $0-$30 and eyewear with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with a $0 copay, but excludes fluoride treatment, maxillofacial prosthetics, implants, and orthodontics. The plan has a maximum benefit of $1500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-271 (PPO) plan, with prior authorization required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 15% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 0 copay and between 10% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $75, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $325, Therapeutic Radiological Services with a copay between $30 and $35, and Outpatient X-Ray Services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-271 (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 H5216-271 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-271 (PPO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $30 copay per visit, and the plan covers up to 20 treatments per year. OTC items are covered with a maximum benefit of $100 every three months, and the plan offers nicotine replacement therapy (NRT) and Naloxone as Part C OTC benefits. The meal benefit has no copay and is for a chronic illness. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, and it does not cover the following 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.
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