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HumanaChoice H5216-316 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-316 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-316 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-316 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-316 (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 H5216-316 (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 H5216-316 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $37.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $420.00 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 H5216-316 (PPO) prescription drug plan has an annual drug deductible of $420. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are available for a $9 copay for a 1-month supply at standard pharmacies, or with no copay for a 3-month supply 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 mail order options. Tier 4 non-preferred drugs require a 48% coinsurance, while Tier 5 specialty drugs have a 28% coinsurance for a 1-month supply. This plan offers various cost-saving opportunities depending on whether you fill your prescriptions at a standard pharmacy or through preferred mail order.
Additional Benefits
The HumanaChoice H5216-316 (PPO) plan offers comprehensive medical coverage featuring no copays or coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, physical therapy, and Medicare-covered dental or hearing exams, members pay a $30 copay with no coinsurance. Inpatient hospital stays require a $280 daily copay for the first five days followed by no copay, while emergency room visits carry a $130 copay with no coinsurance. Additionally, the plan features routine dental, vision, and hearing care with no copays, including up to a $2,500 annual limit for covered dental services. Diagnostic lab tests, home infusion services, and select over-the-counter items are also covered with no copay. For durable medical equipment and medical supplies, members will pay no copay and a coinsurance ranging from 10% to 20%.
Inpatient Hospital See details
HumanaChoice H5216-316 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. Both services require a $280 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-316 (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services have a $0 to $290 copay, observation services require a $280 copay per stay, and outpatient substance abuse sessions have a $30 to $35 copay, with prior authorization required for most services.
Partial Hospitalization See details
HumanaChoice H5216-316 (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 H5216-316 (PPO) covers ground and air ambulance services with a $335 copayment and no coinsurance, though prior authorization is required and the copay is not waived if admitted. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice H5216-316 (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 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-316 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and mental health services require a $30 copay and no coinsurance. Telehealth, opioid treatment, and other professional services are covered with no coinsurance and copays ranging from no copay up to $50, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-316 (PPO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs, with no copay and no coinsurance. Additional preventive services are only partially covered, offering a memory fitness benefit with no copay and no coinsurance, while excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, safety devices, and counseling.
Hearing Services See details
HumanaChoice H5216-316 (PPO) covers hearing services with no coinsurance, offering Medicare-covered exams for a $30 copay, alongside routine exams, fitting evaluations, and OTC hearing aids for no copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $99 to $699, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered under the HumanaChoice H5216-316 (PPO) plan, offering routine eye exams and select eyewear with no copay, no coinsurance, and no deductible. Annual benefits include up to $75 for exams and a combined $250 for eyeglasses or contact lenses, though other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-316 (PPO), which features a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $2,500 annual limit. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-316 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HumanaChoice H5216-316 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-316 (PPO) with an 18% coinsurance and no copay for durable medical equipment (DME). Prosthetic devices require a 15% coinsurance and medical supplies require a 20% coinsurance with no copays, while diabetic supplies have a 10% to 20% coinsurance (no copay) and therapeutic shoes or inserts carry a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-316 (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services feature no coinsurance, offering lab tests with no copay and diagnostic procedures with a $0 to $100 copay, while radiological services range from no copay for X-rays to a $30 copay and 20% coinsurance for therapeutic radiation.
Home Health Services See details
HumanaChoice H5216-316 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the HumanaChoice H5216-316 (PPO) plan require prior authorization with no coinsurance, meaning some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-316 (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 inpatient hospital stay is needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-316 (PPO) covers acupuncture with a $30 copay and no coinsurance, as well as chronic illness meal benefits and select over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and over-the-counter items are provided through reimbursement.
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