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HumanaChoice H5216-275 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-275 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-275 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-275 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Twin Cities Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-275 (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 H5216-275 (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 H5216-275 (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 $615.00 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 H5216-275 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, members enjoy no copay for 1-month or 3-month supplies at standard pharmacies and preferred mail-order services. Tier 2 generics are also highly affordable, with standard pharmacy copays starting at $5 and no copay for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail-order options. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 38% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance.
Additional Benefits
The HumanaChoice H5216-275 (PPO) plan offers robust coverage for essential medical services, featuring no copay for primary care visits and a 65 dollar copay for specialist consultations. Inpatient hospital stays require a 460 dollar daily copay for the first four days followed by no copay, while outpatient hospital services range from no copay to a 300 dollar copay with no coinsurance. Emergency room visits carry a 130 dollar copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable supplemental benefits, such as dental coverage up to a 2,500 dollar annual limit with no copay for preventive and most comprehensive services. Routine vision and hearing exams are available with no copay, and the plan provides a 300 dollar annual allowance for eyewear alongside coverage for over-the-counter items. Additionally, home health services are fully covered with no copay or coinsurance, ensuring affordable care at home.
Inpatient Hospital See details
HumanaChoice H5216-275 (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $460 daily copay for days 1 through 4 and no copay for days 5 and beyond, while psychiatric stays require a $450 daily copay for days 1 through 4 and no copay for days 5 through 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-275 (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $300 and observation services with a $460 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions carry a $30 to $35 copay with no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-275 (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
Ambulance and transportation services are covered by HumanaChoice H5216-275 (PPO), featuring a $335 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Prior authorization is required for all ambulance transports, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services under the HumanaChoice H5216-275 (PPO) plan are covered 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 H5216-275 (PPO) primary care benefits are partially covered, offering no copay and no coinsurance for primary care visits, and a $65 copay with no coinsurance for specialists. While physical, occupational, and speech therapies require a $40 copay and no coinsurance, chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under HumanaChoice H5216-275 (PPO) with no copay and no coinsurance for covered services like annual physicals, memory fitness, and kidney disease education. However, health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing Services under HumanaChoice H5216-275 (PPO) are partially covered and feature no coinsurance across all services. Medicare-covered hearing exams require a $65 copay, while routine exams, fitting evaluations, and OTC hearing aids have no copay. Prescription hearing aids are partially covered with a copay of $699 to $999 for up to two aids per year, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
HumanaChoice H5216-275 (PPO) vision services are partially covered, featuring routine eye exams and eyewear like contact lenses or eyeglasses with no copay and no coinsurance up to a $300 annual limit. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-275 (PPO) partially covers dental services up to a $2,500 annual maximum, offering preventive and most comprehensive services with no copay and no coinsurance, prosthodontics with no copay and 30% coinsurance, and Medicare-covered dental with a $65 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5216-275 (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 10% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-275 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-275 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-275 (PPO) covers diagnostic and radiological services with prior authorization, featuring no copay or coinsurance for lab services and a $0 to $95 copay with no coinsurance for diagnostic procedures. Diagnostic radiological services feature a copay starting at $0, outpatient X-rays have no copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-275 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-275 (PPO) cardiac rehabilitation services require prior authorization and feature no coinsurance, although only some services are covered. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-275 (PPO) covers skilled nursing facility services with no coinsurance, requiring a $10 daily 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 needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-275 (PPO) offers partially covered Other Services, featuring acupuncture with a $65 copay and no coinsurance for up to 20 treatments yearly. Over-the-counter items and chronic illness meal benefits are covered with no copay and no coinsurance, though other miscellaneous services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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