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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 $35.70. 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) plan has an annual prescription drug deductible of $615. Tier 1 preferred generic drugs offer excellent savings with no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, featuring no copay for a 3-month supply through preferred mail order and copays ranging from $5 to $20 for a 1-month supply depending on your pharmacy choice. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply at standard pharmacies, preferred mail order, or standard mail order. Tier 4 non-preferred drugs require a 38% coinsurance for both 1-month and 3-month supplies, while Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply. These tier-based copayments and coinsurance rates help you easily estimate your out-of-pocket prescription costs under this plan.
Additional Benefits
The HumanaChoice H5216-280 (PPO) plan offers robust medical coverage with no copay or coinsurance for primary care visits, home health care, and routine preventive services. Specialist visits require a low $5 copay, while inpatient hospital stays have a $375 daily copay for the first several days and no copay thereafter. Emergency care is available with a $115 copay, and outpatient services feature no coinsurance with copays starting at $0. Supplemental benefits include no copay or coinsurance for most dental services up to a $2,000 annual limit, as well as no copay for routine hearing exams and eyewear. Vision care features a $350 annual allowance for glasses, while hearing aids and diagnostic services are covered with low-to-moderate copays and no coinsurance. Durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HumanaChoice H5216-280 (PPO) with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Under this plan, acute stays require a $375 daily copay for days 1-7 (no copay for days 8-999) and psychiatric stays require a $375 daily copay for days 1-5 (no copay for days 6-90), with prior authorization required.
Outpatient Services See details
HumanaChoice H5216-280 (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most services. There is no copay for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a $35 copay, observation services require a $375 copay per stay, and outpatient hospital services have a copay ranging from $0 to $450.
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, requiring prior authorization. For transportation benefits, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice H5216-280 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-280 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $5 copay and no coinsurance. Physical, occupational, and mental health therapies have copays ranging from $25 to $35 with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-280 (PPO) provides preventive services, such as annual physical exams, kidney disease education, and a memory fitness benefit, with no copay and no coinsurance. Additional preventive benefits are only partially covered, excluding services like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-280 (PPO) hearing services cover Medicare-covered hearing exams for a $5 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $599 for up to two aids every three years, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-280 (PPO) covers vision services with no deductible, no coinsurance, and copays ranging from $0 to $5 for eye exams and no copay for eyewear. This partially covered benefit includes a $40 annual maximum for exams and a $350 annual allowance for eyeglasses or contacts, but does not cover upgrades, standalone lenses, standalone frames, or other eye exam services.
Dental Services See details
HumanaChoice H5216-280 (PPO) dental services are partially covered up to a $2,000 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services require a $5 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
HumanaChoice H5216-280 (PPO) covers Home Infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and between no coinsurance and 20% coinsurance, while Part B insulin has a $35 copay and between no coinsurance and 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 these covered services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-280 (PPO), including 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 or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-280 (PPO) covers diagnostic and radiological services, featuring no coinsurance for diagnostic services, no copay for lab and outpatient X-ray services, and a copay of $0 to $120 for diagnostic procedures. Diagnostic radiological services have a copay starting at $0, while therapeutic radiological services require a minimum 20% coinsurance and a copay starting at $5.00.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-280 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-280 (PPO) covers Cardiac Rehabilitation Services with no coinsurance and required prior authorization, though only some services are covered. Specifically, cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($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 and a prior three-day inpatient hospital stay is not needed, but additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
HumanaChoice H5216-280 (PPO) partially covers other services, offering acupuncture for a $5 copay and no coinsurance up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Both covered services require prior authorization, while over-the-counter (OTC) items are not covered.
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