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HumanaChoice Florida H5216-304 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida H5216-304 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Florida H5216-304 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Florida H5216-304 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Central Florida. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Florida H5216-304 (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 Florida H5216-304 (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 Florida H5216-304 (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 $615.00 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 $8900.00 (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 $8900.00 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:
Sign up for HumanaChoice Florida H5216-304 (PPO)
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Drug Coverage
The HumanaChoice Florida H5216-304 (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay 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 at standard pharmacies, or no copay for a 3-month supply when using preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, which drops to a $131 copay for a 3-month supply through preferred mail order. Higher-tier prescriptions are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 46% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice Florida H5216-304 (PPO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $425 daily copay for the first four days and no copay for days five through 90. Outpatient hospital services and specialist visits are also highly accessible, featuring low copays and no coinsurance. This plan features valuable extra benefits, such as routine vision, hearing, and dental care with no copays, including up to a $1,000 annual maximum for dental services. Emergency care is covered with a $130 copay, while durable medical equipment and dialysis require a 20% coinsurance with no copay. Additionally, members can access acupuncture, over-the-counter items, and short-term meals with no copays and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HumanaChoice Florida H5216-304 (PPO) with no coinsurance, requiring a $425 daily copay for days 1 to 4 and no copay for days 5 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice Florida H5216-304 (PPO) with no coinsurance, featuring a $0 to $225 copay for outpatient hospital services and a $425 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay or coinsurance, while outpatient substance abuse sessions have a $30 to $35 copay.
Partial Hospitalization See details
HumanaChoice Florida H5216-304 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice Florida H5216-304 (PPO), with ground ambulance services requiring a $120 to $240 copay and air ambulance services requiring a 20% coinsurance, both subject to prior authorization. Additional transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Florida H5216-304 (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $15 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice Florida H5216-304 (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and therapy services feature copays ranging from $0 to $35 with no coinsurance. Podiatry and routine chiropractic services are not covered under this plan.
Preventive Services See details
HumanaChoice Florida H5216-304 (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering in-home support services with no copay and no coinsurance, while fitness benefits, health education, nutritional therapy, weight management, PERS, alternative therapies, counseling, and home safety modifications are not covered.
Hearing Services See details
HumanaChoice Florida H5216-304 (PPO) covers hearing services with no copay or coinsurance for annual routine exams, fitting evaluations, and OTC hearing aids, while Medicare-covered exams require a $30 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 limit every three years, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice Florida H5216-304 (PPO) vision services are partially covered, offering no copay and no coinsurance for annual routine eye exams and eyewear such as contact lenses and eyeglasses. Other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Florida H5216-304 (PPO) offers partially covered dental services with a $1,000 annual maximum benefit, featuring no copay and no coinsurance for preventive care, endodontics, periodontics, and oral surgery. Medicare-covered dental services require a $30 copay and no coinsurance, while restorative and prosthodontic services have no copay and 30% to 40% coinsurance; however, fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice Florida H5216-304 (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require no copay and carry no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice Florida H5216-304 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice Florida H5216-304 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $5 copay and coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice Florida H5216-304 (PPO) covers diagnostic and radiological services, requiring no coinsurance and a $0 to $225 copay for diagnostic procedures, and no copay for lab services. Diagnostic radiological services and outpatient X-rays have no copay, while therapeutic radiological services require a minimum 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice Florida H5216-304 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice Florida H5216-304 (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. 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 Florida H5216-304 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $160 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not necessary, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
HumanaChoice Florida H5216-304 (PPO) offers additional services including acupuncture limited to 25 treatments per year, over-the-counter (OTC) items, and short-term meal benefits with no copays and no coinsurance. Prior authorization is required for acupuncture and meals, while other unspecified supplemental services are not covered.
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