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HumanaChoice H5216-285 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-285 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-285 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-285 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Ohio & N KY. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-285 (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 H5216-285 (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 H5216-285 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $250.00 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 $9600.00 (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 $9600.00 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 H5216-285 (PPO) plan features an annual drug deductible of $250. For Tier 1 preferred generic drugs, you pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs require a $5 copay for a 1-month supply at standard pharmacies and 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, though you can save on a 3-month supply with a $131 copay through preferred mail order. Higher-tier prescriptions require coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 48% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance.
Additional Benefits
The HumanaChoice H5216-285 (PPO) plan offers affordable everyday healthcare with no copay or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $40 copay, while inpatient hospital stays incur a $495 daily copay for the first five days. Outpatient hospital services feature copays ranging from no copay up to $500, with no coinsurance required for these key medical services. Supplemental benefits include dental coverage with a $1,500 annual limit and vision coverage up to $350 for eyewear, both featuring no copayments for most covered services. Routine hearing exams and over-the-counter hearing aids also have no copay, though prescription hearing aids require a copay between $699 and $999. For durable medical equipment and dialysis services, members will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-285 (PPO) covers inpatient hospital services with no coinsurance, requiring a $495 daily copay for days 1 to 5 of acute stays and days 1 to 4 of psychiatric stays, followed by no copay for additional covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-285 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $500 copay for outpatient hospital services and a $495 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay or coinsurance, while outpatient substance abuse individual and group sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-285 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-285 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under HumanaChoice H5216-285 (PPO) are covered 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 H5216-285 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Other covered services such as therapy, mental health, and telehealth feature copays ranging from $0 to $50 with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-285 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered with no coinsurance for memory fitness, smoking cessation, and chemotherapy wigs (up to $500 annually), though services like health education, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
HumanaChoice H5216-285 (PPO) hearing services feature no deductible, offering routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Medicare-covered exams require a $40 copay and no coinsurance, while prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, excluding inner ear, outer ear, and over-the-ear models.
Vision Services See details
HumanaChoice H5216-285 (PPO) partially covers Vision Services with no copay, no coinsurance, and no deductible for covered services, though prior authorization is required. Covered benefits include one routine eye exam (up to $40) and contact lenses or eyeglasses (up to $350) annually, while other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by HumanaChoice H5216-285 (PPO), which features a $1,500 annual maximum benefit with no copay and no coinsurance for most preventive and comprehensive dental care. Medicare-covered dental services have a $40 copay and no coinsurance, but fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-285 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, insulin, and other drugs carry a coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
HumanaChoice H5216-285 (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 H5216-285 (PPO), including durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are also covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-285 (PPO) with prior authorization required. Outpatient diagnostic tests have no coinsurance and copays ranging from $0 to $105, lab services and X-rays have no copay, and therapeutic radiology requires a minimum $50 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-285 (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-285 (PPO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, though only some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for PAD are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-285 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 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 H5216-285 (PPO) covers acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and offers meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance, as the plan does not cover all drugs on the CMS OTC list.
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