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HumanaChoice H5216-317 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-317 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-317 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-317 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Kentucky and Southern Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-317 (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 H5216-317 (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 H5216-317 (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 $350.00 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 $9600.00 (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 $9600.00 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 H5216-317 (PPO) prescription drug plan features an annual drug deductible of $350. 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, costing as little as a $5 copay for a 1-month supply, or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply at standard pharmacies and mail-order options. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 48% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance. Knowing these tier structures helps you anticipate your out-of-pocket medication costs under this Medicare Advantage plan.
Additional Benefits
The HumanaChoice H5216-317 (PPO) plan offers robust medical coverage with no copay for primary care physician visits, home health services, and annual physical exams. For inpatient hospital stays, members pay a daily copay of $530 for the first few days and no copay thereafter, while outpatient services range from no copay to a $520 copay. Emergency services are covered with a $130 copay, which is waived if admitted, and urgent care visits require a $50 copay. This plan also features dental, vision, and hearing benefits, offering no copay for routine exams alongside annual allowances of up to $1,500 for dental care and $350 for eyewear. Durable medical equipment and dialysis services require a 20% coinsurance, while diagnostic lab tests and up to 24 one-way transportation trips are covered with no copay. Members also receive extra perks like meal benefits, covered over-the-counter items, and acupuncture treatments with no coinsurance.
Inpatient Hospital See details
Inpatient hospital care under HumanaChoice H5216-317 (PPO) is covered with no coinsurance, requiring prior authorization. Acute stays require a $530 daily copay for days 1 to 5 and no copay for days 6 and beyond, whereas psychiatric stays require a $530 daily copay for days 1 to 4 and no copay for days 5 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-317 (PPO) covers outpatient services with no coinsurance, featuring a $0 copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $520, observation services require a $530 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-317 (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 H5216-317 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-317 (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have 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 H5216-317 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, and speech therapies carry a $5 to $25 copay with no coinsurance, while mental health, psychiatric, and opioid treatments require a $35 copay with no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are covered by HumanaChoice H5216-317 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs. This benefit is partially covered, as a fitness benefit is included with no copay and no coinsurance, but health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice H5216-317 (PPO) with no deductible, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fittings. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $799 (inner ear, outer ear, and over the ear prescription hearing aids are not covered), while over-the-counter hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-317 (PPO), offering eye exams with no coinsurance and copays from $0 to $40, alongside no deductible. Covered eyewear has no copay or coinsurance up to a $350 annual limit for one pair of contact lenses or eyeglasses, while upgrades, separate lenses or frames, and other eye exams are not covered.
Dental Services See details
HumanaChoice H5216-317 (PPO) partially covers dental services, offering Medicare-covered dental care with a $40 copay and no coinsurance, alongside other covered dental services with no copay or coinsurance up to a $1,500 annual limit. While many preventive and restorative services are included, fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-317 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-317 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
HumanaChoice H5216-317 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Covered diabetic supplies require a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-317 (PPO) covers diagnostic and radiological services with prior authorization required, offering lab services, outpatient X-rays, and diagnostic radiological services with no copay. Diagnostic procedures and tests feature a $0 to $100 copay with no coinsurance, while therapeutic radiological services require a minimum $35 copay and 20% coinsurance.
Home Health Services See details
Home health services are covered under the HumanaChoice H5216-317 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-317 (PPO) covers some Cardiac Rehabilitation Services with a $10 copay and no coinsurance, subject to prior authorization. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-317 (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a 3-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services offered by HumanaChoice H5216-317 (PPO) are partially covered, as Dual Eligible SNPs with Highly Integrated Services and other miscellaneous services are not covered. Covered acupuncture requires prior authorization with a $40 copay and no coinsurance for up to 20 treatments yearly, while meal benefits and over-the-counter items—which exclude some CMS OTC list drugs—are available with no copay and no coinsurance.
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