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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 2026, 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 2026.
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 $5.20. 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 $500.00 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 H5216-283 (PPO) Medicare plan features an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a 1-month supply at standard pharmacies and through preferred mail order, with no copay for a 3-month supply when filled via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, with a discounted $131 copay for a 3-month supply through preferred mail order. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 37% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. Standard mail order options are also available for most tiers, though they typically carry higher copay rates.
Additional Benefits
The HumanaChoice H5216-283 (PPO) plan offers robust coverage with no copay or coinsurance for primary care visits, annual physicals, and Medicare preventive services. Specialist visits require a $30 copay, while inpatient hospital stays incur a daily copay of $425 for the first seven days of acute care with no copay thereafter. Emergency care is available with a $130 copay, which is waived if you are admitted, and urgent care has a $50 copay. For specialized care, the plan features no copays for routine dental, vision, and hearing exams, though prescription hearing aids have copays ranging from $699 to $999. Durable medical equipment and dialysis services require a 20% coinsurance, while skilled nursing facility stays have a $10 daily copay for the first 20 days. Home health services are fully covered with no copay or coinsurance, helping to keep out-of-pocket recovery costs low.
Inpatient Hospital See details
HumanaChoice H5216-283 (PPO) covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1-7 of acute stays (no copay for days 8 and beyond) and a $325 daily copay for days 1-7 of psychiatric stays (no copay for days 8-90). This benefit is partially covered, as acute care upgrades and non-Medicare-covered stays are not covered, and psychiatric additional days and non-Medicare-covered stays are also excluded.
Outpatient Services See details
HumanaChoice H5216-283 (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from no copay to $300, while observation services require a $425 copay per stay and substance abuse sessions have a $20 to $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-283 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-283 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-283 (PPO) 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 H5216-283 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Other services like physical and occupational therapy require a $40 copay, mental health and psychiatric services have a $20 copay, and telehealth ranges from a $0 to $50 copay, all with no coinsurance, while podiatry is not covered and only some chiropractic services are covered as routine and other chiropractic services are excluded.
Preventive Services See details
HumanaChoice H5216-283 (PPO) covers Medicare preventive services, annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. While a memory fitness benefit is covered with no copay and no coinsurance, other supplemental preventive services such as health education, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice H5216-283 (PPO), featuring Medicare-covered exams for a $30 copay and no coinsurance, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999, though inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Vision services are covered by HumanaChoice H5216-283 (PPO) with no deductibles or coinsurance, featuring a $0 to $30 copay for eye exams and no copay for eyewear. This benefit is partially covered, offering up to $75 annually for a routine exam and a $150 annual limit for contact lenses or eyeglasses (lenses and frames), while other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-283 (PPO) up to a $2,500 annual maximum, featuring no copay and no coinsurance for most preventive and comprehensive care, though prosthodontics require a 30% coinsurance with no copay and Medicare-covered dental has a $30 copay and no coinsurance. Fluoride treatments, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5216-283 (PPO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
HumanaChoice H5216-283 (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 H5216-283 (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 or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-283 (PPO) covers diagnostic and radiological services, though prior authorization is required. Diagnostic services feature no coinsurance, with no copay for lab services and a copay ranging from $0 to $95 for procedures, while radiological services require no copay for X-rays, a copay starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-283 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-283 (PPO) covers some cardiac rehabilitation services with no copay, no coinsurance, and required prior authorization. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-283 (PPO) covers Skilled Nursing Facility (SNF) 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 necessary, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5216-283 (PPO), which offers acupuncture with a $30 copay and no coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Highly integrated services for dual-eligible SNPs and other miscellaneous services are not covered under this plan.
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