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Humana Full Access H5216-287 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-287 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5216-287 (PPO) in 2026, please refer to our full plan details page.
Humana Full Access H5216-287 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Macomb, Oakland and Wayne counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Full Access H5216-287 (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 Humana Full Access H5216-287 (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 Humana Full Access H5216-287 (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. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $350.00 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 $4800.00 (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 $4800.00 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 Humana Full Access H5216-287 (PPO) plan features an annual prescription drug deductible of $350. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies, with no copay required for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply at standard pharmacies and mail-order services. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 47% coinsurance, and Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply.
Additional Benefits
The Humana Full Access H5216-287 (PPO) plan offers comprehensive coverage with many services requiring no copay and no coinsurance, including primary care physician visits, routine preventive care, and home health services. Members also benefit from generous routine care limits, such as no copays for dental services up to $2,500 annually and vision exams and eyewear up to a $400 annual limit. Additionally, routine hearing exams and over-the-counter hearing aids are covered with no copay, while specialist visits require a $40 copay. For emergency and acute care, the plan features a $130 copay for emergency room visits and a $440 daily copay for the first few days of inpatient hospital stays, with no coinsurance. Other services like durable medical equipment and dialysis require a 20% coinsurance with no copay, while skilled nursing facility stays have a $10 daily copay for the first 20 days. The plan also includes valuable extras like acupuncture for a $40 copay and up to 24 one-way transportation trips with no copay.
Inpatient Hospital See details
Humana Full Access H5216-287 (PPO) inpatient hospital services are partially covered with no coinsurance, requiring a $440 daily copay for days 1 through 6 of acute stays and days 1 through 5 of psychiatric stays, with no copay for subsequent covered days. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Full Access H5216-287 (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $440 (with a $440 copay per stay for observation services), and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Humana Full Access H5216-287 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Full Access H5216-287 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Full Access H5216-287 (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care is covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
Humana Full Access H5216-287 (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Therapy and telehealth services are covered with copays ranging up to $45 and $50 respectively with no coinsurance, while mental health, psychiatric, and opioid treatments cost a $35 copay with no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Full Access H5216-287 (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes training, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for memory fitness, smoking cessation, and chemotherapy wigs up to $500. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home modifications, and counseling.
Hearing Services See details
Humana Full Access H5216-287 (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Over-the-counter hearing aids are covered with no copay and no coinsurance, but prescription hearing aids are only partially covered—excluding inner ear, outer ear, and over-the-ear models—with copays ranging from $99 to $699 and no coinsurance.
Vision Services See details
Humana Full Access H5216-287 (PPO) partially covers vision services with no deductible and no coinsurance, providing routine eye exams and select eyewear with no copay up to a $400 annual limit. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Full Access H5216-287 (PPO) covers Medicare-covered dental services for a $40 copay and no coinsurance, while other dental services are partially covered with no copay and no coinsurance up to a $2,500 annual limit. Preventive and comprehensive services like cleanings, exams, and root canals are included, but fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered with no copay under the Humana Full Access H5216-287 (PPO) plan, subject to prior authorization and step therapy. Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Full Access H5216-287 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Full Access H5216-287 (PPO) covers durable medical equipment, prosthetic devices, 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 and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Full Access H5216-287 (PPO) with prior authorization, offering no copay for lab services and outpatient X-rays, though coinsurance applies. Other diagnostic procedures and therapeutic radiological services require a 20% coinsurance with copays ranging up to $105, with a maximum single copay applying for multiple same-day services at one location.
Home Health Services See details
Home Health Services are covered by Humana Full Access H5216-287 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Full Access H5216-287 (PPO) with a $10 copay, no coinsurance, and prior authorization requirements. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Full Access H5216-287 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Humana Full Access H5216-287 (PPO) offers other covered services including acupuncture with a $40 copay and no coinsurance, up to a limit of 20 treatments per year. Over-the-counter items and qualifying meal benefits are also fully covered with no copay and no coinsurance.
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