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HumanaChoice H5216-289 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-289 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-289 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-289 (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 H5216-289 (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 H5216-289 (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 H5216-289 (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 has a $215.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $400.00 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 $6950.00 (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 $6950.00 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 H5216-289 (PPO) prescription drug plan features an annual drug deductible of $400. Tier 1 preferred generic medications offer excellent savings, requiring 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, with a $5 copay for a 1-month supply and no copay for a 3-month supply when filled through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply at standard pharmacies and through mail order options. Medications in the higher tiers require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 38% coinsurance and Tier 5 specialty drugs requiring a 28% coinsurance. These tier-based costs make it easy to estimate your monthly and yearly out-of-pocket medication expenses.
Additional Benefits
The HumanaChoice H5216-289 (PPO) plan offers comprehensive coverage featuring no copay and no coinsurance for primary care doctor visits, routine physicals, and home health services. Specialist visits, physical therapy, and Medicare-covered dental care require a $40 copay with no coinsurance. For hospital stays, members pay a $335 daily copay for days one through seven of acute inpatient care, while outpatient hospital services range from no copay up to a $660 copay. Additional benefits include routine dental, vision, and hearing exams with no copay and no coinsurance, alongside covered over-the-counter items and meals for chronic illnesses. Emergency room visits carry a $130 copay, which is waived if admitted within 24 hours, while urgent care visits require a $50 copay. Furthermore, the plan covers up to 24 one-way trips per year for health-related transportation with no copay and no coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-289 (PPO) offers partial coverage for inpatient hospital services with no coinsurance, featuring a $335 daily copay for days 1 to 7 of acute stays and a $311 daily copay for days 1 to 7 of psychiatric stays. There is no copay for days 8 and beyond, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-289 (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $660, observation services require a $335 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-289 (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 H5216-289 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance per service. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-289 (PPO) with a $130 copay and no coinsurance, with the copay 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 H5216-289 (PPO) features primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $40 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $35 copay with no coinsurance, and telehealth benefits range from a $0 to $50 copay with no coinsurance. Podiatry and routine chiropractic services are not covered under these benefits.
Preventive Services See details
HumanaChoice H5216-289 (PPO) preventive services are partially covered with no copay and no coinsurance for covered benefits like annual physical exams, smoking cessation, memory fitness, and kidney disease education. Sub-services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, 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 safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-289 (PPO) covers hearing exams with no coinsurance, requiring a $40 copay for Medicare-covered exams and no copay for routine exams or fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a $399 to $699 copay for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice H5216-289 (PPO) partially covers vision services with no deductible, no coinsurance, and no copay for routine eye exams and select eyewear like contact lenses and eyeglasses. Other eye exams, standalone eyeglass lenses, standalone frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-289 (PPO) partially covers dental services with a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5216-289 (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 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 H5216-289 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-289 (PPO) covers durable medical equipment with an 18% coinsurance and no copay, and prosthetics 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 and no coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H5216-289 (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic tests and lab services, which feature copays ranging from $0 to $85 and no copay respectively. Diagnostic radiology services have copays starting at $0, outpatient X-rays have no copay, and therapeutic radiology services carry a 20% coinsurance.
Home Health Services See details
Home health services are covered under the HumanaChoice H5216-289 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-289 (PPO) Cardiac Rehabilitation Services require prior authorization and have no coinsurance, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered, with copays for these services ranging from $15 to $40.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-289 (PPO) 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, no prior three-day hospital stay is needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-289 (PPO) provides partial coverage for other services, featuring acupuncture for a $40 copay and no coinsurance for up to 20 treatments per year. Additionally, over-the-counter items and meal benefits for chronic illnesses are covered with no copay and no coinsurance, though prior authorization may be required for acupuncture and meals.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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