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HumanaChoice H5216-300 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-300 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-300 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-300 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Mississippi. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-300 (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 H5216-300 (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 H5216-300 (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 has a $555.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 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 $8950.00 (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 $8950.00 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 H5216-300 (PPO) Medicare prescription drug plan features an annual drug deductible of $590. For Tier 1 preferred generic drugs, you will 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 highly affordable, starting at a $5 copay for a 1-month supply and featuring no copay for a 3-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, the plan features a $47 copay for a 1-month supply, which rises to a maximum of $141 for a 3-month supply. Higher-tier medications require coinsurance instead of flat copays, with Tier 4 non-preferred drugs carrying a 31% coinsurance for both 1-month and 3-month supplies. Finally, Tier 5 specialty drugs require a 26% coinsurance for a 1-month supply regardless of whether you use standard pharmacies or mail order services.
Additional Benefits
The HumanaChoice H5216-300 (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $45 copay, while inpatient hospital stays incur a daily copay of $280 for the first nine days of acute stays with no coinsurance. Outpatient hospital services feature copays ranging from no copay to $350, alongside no copay for ambulatory surgical center services. Beneficiaries can also take advantage of dental, vision, and hearing benefits, which feature no copays or coinsurance for routine dental care up to $2,500 annually and routine eye exams. Emergency care is available with a $130 copay, while durable medical equipment and dialysis require coinsurance of 19% and 20% respectively with no copays. Additionally, routine hearing exams have no copay, and prescription hearing aids are covered with copays ranging from $599 to $899.
Inpatient Hospital See details
HumanaChoice H5216-300 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $280 daily copay for days 1 to 9 of acute stays and a $262 daily copay for days 1 to 9 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-300 (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $350, observation services carry a $280 copay per stay, and outpatient substance abuse sessions have a $35 copay, with prior authorization required for these services.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-300 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-300 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay. Prior authorization is required for all ambulance services, and non-emergency transportation services to health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-300 (PPO) covers emergency services 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 H5216-300 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Therapy services require a $30 copay and mental health services require a $35 copay, both with no coinsurance, while podiatry services are not covered. Some chiropractic services are covered, but routine and other chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-300 (PPO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered; fitness and in-home support services are covered with no copay and no coinsurance, but sub-services like health education, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice H5216-300 (PPO), which includes Medicare-covered exams for a $45 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $599 to $899 and no coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-300 (PPO) partially covers vision services with no coinsurance, no deductibles, and no copays for routine eye exams and eyewear, though prior authorization is required. Routine exams and eyewear (contacts or eyeglasses) are capped at $75 and $200 annually, respectively, while other eye exams, separate lenses or frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-300 (PPO) offers partially covered dental services with no copay and no coinsurance for preventive and comprehensive care up to an annual maximum of $2,500. Medicare-covered dental services require a $45 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-300 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have between no coinsurance and 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-300 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-300 (PPO), featuring a 19% coinsurance and no copay for durable medical equipment (DME), and a 20% coinsurance with no copay for prosthetic devices and medical supplies. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-300 (PPO) covers diagnostic and radiological services, offering lab services, outpatient X-rays, and diagnostic radiological services with no copay and no coinsurance. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $75, while therapeutic radiological services require a minimum 20% coinsurance and a copay of at least $45.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-300 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-300 (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. Some services are covered, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered and carry a $15 copay.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-300 (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-300 (PPO) offers partial coverage for other services, featuring acupuncture with a $45 copay and no coinsurance for up to 20 treatments per year, and chronic illness meals with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
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