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HumanaChoice H5216-284 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-284 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-284 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-284 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Georgia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-284 (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 H5216-284 (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 H5216-284 (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 H5216-284 (PPO) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing as little as no copay for a 3-month supply via preferred mail order or a $5 copay for a 1-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 37% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. These structured costs help HumanaChoice H5216-284 (PPO) members budget effectively for their specific medication needs.
Additional Benefits
The HumanaChoice H5216-284 (PPO) plan offers robust medical coverage with no copay for primary care visits and preventive services, while specialist visits require a $30 copay. For hospital care, inpatient acute stays incur a $375 daily copay for the first seven days before dropping to no copay, whereas outpatient hospital services range from no copay up to a $450 copay. Emergency room visits carry a $115 copay, which is waived if you are admitted within 24 hours. This plan also includes essential support services like home health care with no copay, alongside dental, vision, and hearing benefits that feature no copay for routine care and exams. For specialized medical needs, you will pay a 20% coinsurance with no copay for dialysis and durable medical equipment. Prescription hearing aids are covered with copays ranging from $699 to $999, while advanced dental services require a 30% to 40% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-284 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for subsequent days. While unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-284 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Patients will pay no copay and no coinsurance for ambulatory surgical center and blood services, while outpatient substance abuse sessions incur a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice H5216-284 (PPO) for a $35.00 copay and no coinsurance, with prior authorization required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice H5216-284 (PPO) with a $335 copay and no coinsurance for Medicare-covered ground and air ambulance services, which require prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered under the HumanaChoice H5216-284 (PPO) plan with a $115 copay and no coinsurance, which is 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 H5216-284 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Therapy and psychiatric services require copays of $25 to $35 with no coinsurance, podiatry is not covered, and only some chiropractic services are covered since routine and other chiropractic services are not.
Preventive Services See details
HumanaChoice H5216-284 (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered; a memory fitness program is included with no copay, but services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-284 (PPO), which offers Medicare-covered exams for a $30 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay, no deductible, and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay between $699 and $999, while OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-284 (PPO) offers partially covered vision services with no deductibles and no coinsurance, featuring a $0 to $30 copay for eye exams and no copay for eyewear. While routine eye exams, contact lenses, and eyeglasses are covered up to annual limits, other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-284 (PPO) dental services are partially covered up to a $1,000 combined annual limit, offering preventive care and select advanced services with no copay and no coinsurance. Other restorative and prosthodontic services require a 30% to 40% coinsurance and no copay, while Medicare-covered dental has a $30 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-284 (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while covered insulin has a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-284 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-284 (PPO) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the HumanaChoice H5216-284 (PPO) plan, with prior authorization required. Diagnostic services have no coinsurance, offering no copay for lab services and a copay between $0 and $120 for diagnostic procedures. Therapeutic radiological services require a minimum 20% coinsurance and a minimum $30 copay, while diagnostic radiological services have no copay and outpatient X-rays require coinsurance with no copay.
Home Health Services See details
Home health services are covered under the HumanaChoice H5216-284 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-284 (PPO) provides cardiac rehabilitation services with no coinsurance, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease are not covered. These non-covered services require prior authorization and carry copayments ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-284 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-284 (PPO) partially covers other services, featuring acupuncture with a $30 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered.
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