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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 2025, 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 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $2.50. You must continue to pay paying your reduced 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 $300.00 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:
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Drug Coverage
The HumanaChoice Florida H5216-304 (PPO) plan has a $300 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay no copay at a standard pharmacy or through mail order, but a $20 copay at a standard mail order pharmacy. For standard generic drugs, you will pay a $47 copay at all pharmacies. For preferred brand drugs, you will pay 35% coinsurance at all pharmacies.
Additional Benefits
The HumanaChoice Florida H5216-304 (PPO) plan offers coverage for a range of services, including inpatient and outpatient hospital care with varying copays. You'll have no copay for primary care visits, but specialist visits have a $30 copay, and mental health services have a $30 copay. Preventive services, such as an annual physical exam, have no copay. The plan also covers hearing and vision services, including hearing exams with a $30 copay and eye exams with no copay, and eyewear with no copay. Dental services include oral exams and dental x-rays with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered, with a $275 copay for days 1-4 and no copay for days 5-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades are not covered. Inpatient hospital psychiatric services are covered, with a $275 copay for days 1-4 and no copay for days 5-90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $225, observation services with a $275 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $30 and $50 for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice Florida H5216-304 (PPO) plan. Ground ambulance services have a copay between $120 and $240, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the HumanaChoice Florida H5216-304 (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $15 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
For the HumanaChoice Florida H5216-304 (PPO) plan, primary care physician services have no copay, chiropractic services have a $20 copay, occupational therapy services have a copay between $10 and $30, and specialist services have a $30 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, physical therapy and speech-language pathology services have a copay between $10 and $30, and additional telehealth benefits have a copay between $0 and $30. Opioid treatment program services have a copay between $30 and $50. Routine Chiropractic Care, and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services with a copay, including in-home support services. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit have no copay.
Hearing Services See details
The HumanaChoice Florida H5216-304 (PPO) plan provides coverage for hearing services, including hearing exams with a $30 copay, and OTC hearing aids with a maximum benefit of $50 every three months. Prescription hearing aids are not covered, nor are routine hearing exams or fitting/evaluations for hearing aids.
Vision Services See details
The HumanaChoice Florida H5216-304 (PPO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Florida H5216-304 (PPO) plan covers a range of dental services, including oral exams with no copay, and dental x-rays with no copay. Other services such as Prosthodontics (removable and fixed) have a 30% coinsurance with no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has an annual maximum of $1,000 for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Florida H5216-304 (PPO) plan and require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. The plan also covers Diabetic Supplies with a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay ranging from $0 to $225, and lab services with no copay. Therapeutic Radiological Services have a copay of up to $30 and a coinsurance of up to 20%, while outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Florida H5216-304 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Florida H5216-304 (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $160.
Other Services See details
The HumanaChoice Florida H5216-304 (PPO) plan covers acupuncture with no copay, and over-the-counter items with a maximum benefit of $50 every three months. Other services, including meal benefits, are not covered.
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