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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 2025, 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 2025.
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 $35.00. 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 $250.00 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 $5200.00 (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 $5200.00 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) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you'll pay a $9 copay for preferred generic drugs at a standard or preferred mail pharmacy. For preferred brand drugs, you will pay 38% coinsurance.
Additional Benefits
The HumanaChoice H5216-316 (PPO) plan offers a range of benefits with varying cost-sharing. This plan includes no copay for primary care, preventive services, routine hearing and vision exams, and many dental services. It also covers inpatient hospital stays with a $290 copay for the first few days, and services like outpatient care, emergency services, and specialist visits have copays that vary. The plan covers services such as ambulance, partial hospitalization, and home health with copays or coinsurance. You will also find coverage for hearing aids, vision eyewear, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a $290 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $250, Observation Services with a $290 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-316 (PPO) plan, with a $30 copay and prior authorization required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice H5216-316 (PPO). Ground and Air Ambulance Services have a $315 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, while Urgently Needed Services has a $55 copay; all services have no coinsurance.
Primary Care See details
The HumanaChoice H5216-316 (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational therapy services have a $30 copay, while physician specialist services have a $30 copay. Mental health specialty services and psychiatric services have a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
The HumanaChoice H5216-316 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered with no copay for services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Certain services such as health education, in-home safety assessment, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with coverage for all types of hearing aids costing between $99 and $399 per visit. OTC hearing aids are covered up to $60 every three months.
Vision Services See details
The HumanaChoice H5216-316 (PPO) plan covers vision services, including eye exams with a copay of $0 to $30 and eyewear with no copay, but eyeglasses lenses, eyeglass frames, and upgrades are not covered. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay.
Dental Services See details
HumanaChoice H5216-316 (PPO) covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. The plan has a $2,000 maximum benefit per year for in and out-of-network services, and fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-316 (PPO) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered under the HumanaChoice H5216-316 (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Prosthetics/Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $100, lab services with no copay, and all radiological services. Diagnostic radiological services have a copay up to $325, therapeutic radiological services have a $30 copay, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-316 (PPO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice H5216-316 (PPO) plan, but are not covered in practice. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-316 (PPO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The HumanaChoice H5216-316 (PPO) plan covers acupuncture with a $30 copay, and over-the-counter items with a maximum benefit coverage amount of $60 every three months. The plan also provides a meal benefit with no copay. Other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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