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HumanaChoice H5216-288 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-288 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-288 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-288 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Connecticut. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-288 (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 H5216-288 (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 H5216-288 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.20. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $275.00 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 $6500.00 (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 $6500.00 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 H5216-288 (PPO) Medicare plan features an annual prescription drug deductible of $275. For Tier 1 preferred generic drugs, beneficiaries pay no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also affordable, with a $5 copay for a 1-month supply at standard pharmacies and no copay for a 3-month supply when filled via preferred mail order. Tier 3 preferred brand drugs have a standard $47 copay for a 1-month supply, though a 3-month supply through preferred mail order reduces the cost to a $131 copay. For higher-tier medications, beneficiaries are responsible for a 45% coinsurance on Tier 4 non-preferred drugs and a 29% coinsurance on Tier 5 specialty drugs. This clear cost-sharing structure helps you easily plan your prescription medication expenses with this HumanaChoice PPO plan.
Additional Benefits
The HumanaChoice H5216-288 (PPO) plan offers robust coverage with no copays for primary care visits, preventive services, and home health care. Specialist visits require a $30 copay, while inpatient hospital stays cost a $295 daily copay for the first seven days and no copay for subsequent days. Emergency room visits have a $130 copay, which is waived if you are admitted to the hospital within 24 hours. For routine care, the plan features no copays for annual dental and vision exams, including up to $1,500 in comprehensive dental benefits and $200 for eyewear. Prescription hearing aids are covered with copays ranging from no copay to $299, while routine hearing exams have no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5216-288 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 to 7 and no copay for days 8 to 90 for both acute and psychiatric stays. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-288 (PPO) covers outpatient hospital services with a $0 to $700 copay and no coinsurance, and observation services with a $295 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $30 to $35 copay and no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-288 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HumanaChoice H5216-288 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered in practice.
Emergency Services See details
HumanaChoice H5216-288 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services require a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-288 (PPO) primary care benefits include doctor visits with no copay and no coinsurance, while specialist visits, therapy, and mental health services require a $30 copay and no coinsurance. Telehealth services are available with a $0 to $50 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-288 (PPO) preventive services are partially covered with no copays and no coinsurance for covered services like annual physicals, kidney disease education, glaucoma screenings, and memory fitness. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-288 (PPO), which features a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with no coinsurance and copays between $0 and $299 for up to two aids every three years, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-288 (PPO) offers partial coverage for vision services with no deductibles, no coinsurance, and no copays for covered routine exams and select eyewear. The plan covers one routine eye exam (up to $75 yearly) and one pair of contact lenses or eyeglasses (up to $200 yearly) with prior authorization, but other eye exams, separate lenses or frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-288 (PPO) provides partially covered dental services, featuring a $30 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for other covered preventive and comprehensive services up to a $1,500 annual maximum. Fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-288 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by HumanaChoice H5216-288 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical Equipment benefits under HumanaChoice H5216-288 (PPO) cover durable medical equipment (DME), prosthetics, and medical supplies with a 20% coinsurance and no copay, subject to prior authorization. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay, with brand selection limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice H5216-288 (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and tests have no coinsurance and a copay of $0 to $100, while lab services and outpatient X-rays have no copay. Diagnostic radiological services have no minimum copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-288 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-288 (PPO) cardiac rehabilitation services require prior authorization and have no coinsurance. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-288 (PPO) covers Skilled Nursing Facility (SNF) care 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, though a three-day prior hospital stay is not, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
HumanaChoice H5216-288 (PPO) covers acupuncture with a $30.00 copay and no coinsurance for up to 20 treatments per year, as well as chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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