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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 2025, 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 2025.
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 $3.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $700.00 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 $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) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you'll pay a $10 copay for preferred generic drugs at a preferred or mail-order pharmacy, while standard generic drugs have a $47 copay. Brand name drugs have 50% coinsurance, and non-preferred drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The HumanaChoice H5216-275 (PPO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient hospital stays, outpatient services, and emergency services, with copays and coinsurance amounts depending on the specific service. The plan also covers primary care and preventive services with no copays, as well as hearing, vision, and dental services with some cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services. For acute inpatient hospital stays, you will pay a $460 copay for days 1-4, and no copay for days 5-90; additional days have no copay. For psychiatric stays, you will pay a $450 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $500, and observation services with a $460 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have copays ranging from $45 to $95 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-275 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-275 (PPO) plan. Air Ambulance Services have a 20% coinsurance, while Ground Ambulance Services have a $315 copay; however, 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 under the HumanaChoice H5216-275 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay.
Primary Care See details
The HumanaChoice H5216-275 (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, occupational therapy services have a $40 copay, and physician specialist services have a $65 copay.
Preventive Services See details
The HumanaChoice H5216-275 (PPO) plan covers preventive services, including an annual physical exam with no copay. Other services like Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit also have no copay. Some preventive services, such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $65 copay, while routine hearing exams are covered with no copay for one exam every year. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) requiring a copay between $699 and $999 for two hearing aids every year, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are covered with a maximum benefit of $50 for both ears combined every three months.
Vision Services See details
The HumanaChoice H5216-275 (PPO) plan covers vision services including eye exams and eyewear. Eye exams have a copay of $0-$65, and eyewear has a copay of $0, with a combined maximum benefit of $300 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-275 (PPO) plan covers dental services including oral exams and dental x-rays with no copay, as well as other diagnostic and preventive services, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a $3,000 annual maximum for dental services, and some services require prior authorization. Prosthodontics, removable and fixed, have a 30% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-10%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0-10%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-275 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage under the HumanaChoice H5216-275 (PPO) plan includes Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 2% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 15% coinsurance, and Medical Supplies have a 10% coinsurance. Diabetic Supplies have a 10% to 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services are covered. Diagnostic procedures/tests have a copay between $0 and $95, while lab services have no copay. Radiological services include diagnostic and therapeutic services, with diagnostic services having a copay up to $460 and therapeutic services having a 20% coinsurance. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-275 (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-275 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-275 (PPO) with a copay of $10 for days 1-20, and $203 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for acupuncture with a $65 copay, and a meal benefit with no copay. This plan also covers Over-the-Counter (OTC) Items, and offers a maximum plan benefit coverage amount of $50 every three months. However, 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 are not covered.
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