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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 2025, 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 2025.
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.
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 $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 $5200.00 (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 $5200.00 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 has a $350 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for a standard pharmacy, you will pay a $5 copay for preferred generic drugs, a $47 copay for standard generic drugs, and 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Full Access H5216-287 (PPO) plan offers comprehensive coverage with varying costs. The plan includes coverage for inpatient and outpatient services, with copays ranging from $0 to $440, and also covers emergency, primary care, preventive, hearing, vision, and dental services. This plan provides additional benefits such as ambulance and transportation services, home health services, and medical equipment, with associated copays and coinsurance. The plan also covers services like acupuncture and over-the-counter items, and has a $2,000 maximum annual benefit for dental services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $440 for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute have no copay for days 91-999, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric has a copay of $440 for days 1-5 and no copay for days 6-90, but additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $440, and observation services with a $440 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have copays ranging from $40 to $95. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Full Access H5216-287 (PPO) plan, with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
The Humana Full Access H5216-287 (PPO) plan covers ambulance services with a $315 copay for both ground and air ambulance services, and transportation services with no copay for plan-approved health-related locations, up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Full Access H5216-287 (PPO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $55 copay, both with no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay, with no coinsurance.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, and a $10-$45 copay for Occupational Therapy Services. Physician Specialist Services have a $40 copay, while Mental Health Specialty Services, including both individual and group sessions, have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a copay between $10 and $45. Additional Telehealth Benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a copay between $40 and $95.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and an annual physical exam with no copay. Additional preventive services are also covered, but require a copay. Wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, and the fitness benefit are also covered with no copay. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered with no copay.
Hearing Services See details
The Humana Full Access H5216-287 (PPO) plan covers hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. The plan also covers prescription hearing aids with a copay between $399 and $999, and OTC hearing aids with a maximum benefit of $50 every three months.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $40, while routine eye exams have no copay. Eyewear has no copay, with a combined maximum benefit of $250 every year for contact lenses and eyeglasses (lenses and frames); however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Full Access H5216-287 (PPO) plan covers Medicare Dental Services with a $40 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, all with no copay. Fluoride treatment and orthodontics are not covered, and there is a $2,000 maximum plan benefit coverage per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Full Access H5216-287 (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and between 0% and 20% coinsurance; other Medicare Part B drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Full Access H5216-287 (PPO) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. DME has a 20% coinsurance, while Prosthetic Devices, Medical Supplies, and Medicare-covered Diabetic Therapeutic Shoes or Inserts have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a maximum copay of $105 and a minimum coinsurance of 20%, Lab Services with no copay, Diagnostic Radiological Services with a maximum copay of $485, Therapeutic Radiological Services with a maximum copay of $40 and a minimum coinsurance of 20%, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5216-287 (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 not covered by the Humana Full Access H5216-287 (PPO) plan. Prior authorization is required for this service, and there is a copay for some cardiac and pulmonary rehabilitation services, but these services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Humana Full Access H5216-287 (PPO) plan, but require prior authorization. The plan has a copay of $10 for days 1-20, and $214 for days 21-100, with no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Full Access H5216-287 (PPO) plan covers acupuncture with a $40 copay, and over-the-counter items with a maximum benefit of $50 every three months, and meal benefits with no copay. Some other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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