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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 2026, 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 2026.
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 $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $400.00 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 $9500.00 (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 $9500.00 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) Medicare plan features an annual drug deductible of $590. For Tier 1 preferred generic drugs, you will pay no copay for one-month or three-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply at standard pharmacies and featuring no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply across standard pharmacies and mail-order options. For higher-tier medications, Tier 4 non-preferred drugs carry a 40% coinsurance, while Tier 5 specialty drugs require a 26% coinsurance for a one-month supply. This structured plan helps you easily anticipate your prescription medication costs throughout the year.
Additional Benefits
The HumanaChoice H5216-271 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits and a $30 copay for specialists. Emergency room visits require a $130 copay, which is waived if admitted, while urgent care visits carry a $50 copay. For inpatient hospital stays, members pay a $299 daily copay for days 1 through 8, with no copay required for additional days. Routine healthcare needs are well-supported with no copay for annual physicals, routine eye exams, and routine hearing exams. Most preventive and comprehensive dental services are also covered with no copay up to a $1,500 annual limit. Additionally, home health services and over-the-counter items have no copay, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-271 (PPO) covers inpatient hospital services with no coinsurance, requiring a $299 daily copay for days 1 to 8 of acute stays (with no copay for days 9 and beyond) and a $272 daily copay for days 1 to 8 of psychiatric stays (with no copay for days 9 to 90). Upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
HumanaChoice H5216-271 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $299 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-271 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-271 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-271 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-271 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Therapy services require a $20 copay and no coinsurance, podiatry is not covered, and while some chiropractic services are covered, routine chiropractic care and other chiropractic services are not.
Preventive Services See details
HumanaChoice H5216-271 (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, in-home support, and fitness benefits. Several supplemental preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies.
Hearing Services See details
HumanaChoice H5216-271 (PPO) covers hearing exams with no coinsurance, requiring a $30 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $99 to $699 for up to two devices per year, though inner ear, outer ear, and over the ear prescription hearing aids are not covered. Unlimited over-the-counter (OTC) hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice H5216-271 (PPO) partially covers vision services with no coinsurance, offering no copay for annual routine eye exams and covered eyewear like contact lenses or complete eyeglasses. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-271 (PPO) offers partially covered dental services with no copay and no coinsurance for most preventive and comprehensive care up to a $1,500 annual limit, while Medicare-covered dental services require a $30 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-271 (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by HumanaChoice H5216-271 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-271 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, with prior authorization required. Diabetic supplies are limited to specified manufacturers and carry a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-271 (PPO) with prior authorization, featuring no coinsurance for diagnostic tests and no copay for lab services or outpatient X-rays. Other diagnostic procedures carry a copay of $0 to $75, while therapeutic radiological services require a minimum $30 copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-271 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-271 (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered in practice and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-271 (PPO) with no coinsurance, featuring no 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 100 days are not covered.
Other Services See details
HumanaChoice H5216-271 (PPO) covers other services including acupuncture for a $30 copay and no coinsurance, up to 20 treatments per year. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though prior authorization is required for acupuncture and meal benefits.
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