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HumanaChoice H5216-283 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-283 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-283 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-283 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in IL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-283 (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 H5216-283 (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 H5216-283 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.80. 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 has a $100.00 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 H5216-283 (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. In the initial coverage phase, you will pay a copay of $10-$47 or 25%-41% coinsurance for your prescriptions depending on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-283 (PPO) plan offers comprehensive coverage, including inpatient hospital stays with copays, outpatient services with varying copays, and emergency services with a $125 copay. The plan also provides coverage for primary care with no copay, preventive services with no copay for many services, and coverage for hearing, vision, and dental services with copays and coinsurance. Additional benefits include home health services with no copay, and coverage for medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $425 per day for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $325 per day for days 1-7 and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay between $0 and $300, and observation services with a $425 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have copays between $30 and $95 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-283 (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 H5216-283 (PPO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the HumanaChoice H5216-283 (PPO) plan with a $125 copay, while urgently needed services have a $55 copay; there is no coinsurance for either. Worldwide emergency services, including coverage and transportation, are also covered, each with a $125 copay and no coinsurance.
Primary Care See details
The HumanaChoice H5216-283 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $30 copay. Mental health specialty services and psychiatric services have a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits range from no copay to a $55 copay. Opioid Treatment Program Services have a copay that ranges from $30 to $95.
Preventive Services See details
The HumanaChoice H5216-283 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services and kidney disease education services are covered, with no copay for services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The HumanaChoice H5216-283 (PPO) plan covers hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types but not for inner ear, outer ear, or over the ear aids. OTC hearing aids are covered up to $50 every three months.
Vision Services See details
The HumanaChoice H5216-283 (PPO) plan covers vision services, including eye exams with a copay of $0-$30. Eyewear is covered with no copay, and includes contact lenses and eyeglasses (lenses and frames), with a combined maximum of $200 every year, and eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-283 (PPO) plan covers dental services with a $3,000 annual maximum. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Prosthodontics (removable and fixed) has a 30% coinsurance and no copay. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-283 (PPO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices, Medicare-covered Medical Supplies, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $95, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $350, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-283 (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $203 copay.
Other Services See details
Other Services include acupuncture with a $30 copay, over-the-counter (OTC) items, and a meal benefit with no copay. The OTC benefit offers a $50 maximum benefit every three months, and the meal benefit is for a chronic illness. Several other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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