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HumanaChoice H5216-280 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-280 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-280 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-280 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Georgia and South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-280 (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 H5216-280 (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 H5216-280 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.40. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $13900.00 (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 $13900.00 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 H5216-280 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies or preferred mail order, with no copay for a 3-month supply when using 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 medications, Tier 4 non-preferred drugs carry a 38% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. These cost-sharing details help you understand your potential out-of-pocket expenses under this Humana Medicare PPO plan.
Additional Benefits
The HumanaChoice H5216-280 (PPO) plan offers robust coverage with no copays and no coinsurance for primary care visits, specialist consultations, preventive services, and home health care. For hospital stays, there is no coinsurance, though inpatient admissions require a $375 daily copay for the first few days, and outpatient hospital services range from no copay up to a $450 copay. Emergency room visits require a $115 copay, which is waived upon hospital admission, while urgent care services carry a $40 copay. Essential ancillary benefits include dental, vision, and hearing coverage, featuring no copays for routine exams and preventive dental care. Vision eyewear is covered up to a $150 annual limit, hearing aids require a copay of $399 to $699, and restorative dental care is subject to a 30% to 40% coinsurance. Diagnostic lab tests and outpatient X-rays are provided with no copay, while durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-280 (PPO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-280 (PPO) outpatient services are covered with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $450, while observation services cost a $375 copay per stay and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-280 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-280 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-280 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-280 (PPO) provides primary care and specialist physician services with no copay and no coinsurance. Therapy services require a $25 copay and no coinsurance, while mental health, psychiatric, and opioid treatment sessions have a $35 copay and no coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not covered, and podiatry is not covered.
Preventive Services See details
Preventive Services are partially covered under HumanaChoice H5216-280 (PPO) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, and memory fitness. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, weight management programs, alternative therapies, and caregiver support.
Hearing Services See details
Hearing services are covered by HumanaChoice H5216-280 (PPO) with no deductible, offering no copay and no coinsurance for Medicare-covered exams, one annual routine exam, and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $699 for up to two devices per year, while inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision Services under HumanaChoice H5216-280 (PPO) are partially covered with no copay and no coinsurance, including up to $75 annually for one routine eye exam and a $150 annual limit for eyewear. Covered eyewear is limited to one annual pair of contact lenses or eyeglasses (lenses and frames), while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-280 (PPO) partially covers dental services up to a $1,250 annual maximum, offering covered preventive and basic procedures with no copay and no coinsurance, while restorative and prosthodontic services require no copay and 30% to 40% coinsurance. Fluoride treatments, implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5216-280 (PPO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-280 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
HumanaChoice H5216-280 (PPO) covers medical equipment, featuring a 20% coinsurance and no copay for durable medical equipment, prosthetic devices, and medical supplies. Covered diabetic supplies carry a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-280 (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic tests have no coinsurance and a copay ranging from $0 to $120, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance with a copay starting at $0.
Home Health Services See details
HumanaChoice H5216-280 (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 covered by the HumanaChoice H5216-280 (PPO) plan with no coinsurance and require prior authorization, but some services are covered while Cardiac Rehabilitation (with a $30 copay), Intensive Cardiac Rehabilitation (with a $30 copay), Pulmonary Rehabilitation (with a $25 copay), and SET for PAD services (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-280 (PPO) covers Skilled Nursing Facility (SNF) services 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, but a prior three-day inpatient hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered under HumanaChoice H5216-280 (PPO), which offers acupuncture limited to 20 treatments per year and chronic illness meal benefits with no copay and no coinsurance, subject to prior authorization. Over-the-counter (OTC) items are not covered under this plan.
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