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HumanaChoice H5216-318 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-318 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-318 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-318 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Kansas, Missouri and Illinois. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-318 (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 H5216-318 (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 H5216-318 (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 $5.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $400.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6200.00 (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 $6200.00 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 H5216-318 (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $10 copay at a standard pharmacy for preferred generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The HumanaChoice H5216-318 (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for ambulance and emergency services. It also covers primary care visits with no copay, preventive services with no copay for annual exams, and hearing and vision services, with copays and specific coverage limits for hearing aids and eyewear. Additional benefits include dental services with a $3,500 annual maximum, home infusion, dialysis, and medical equipment with varying copays and coinsurance. The plan also covers diagnostic and radiological services, home health, cardiac rehabilitation, and skilled nursing facility stays, with copays and prior authorization requirements for some services. Other covered services include acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-5, you will pay a $295 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $300, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $35 copay for both 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 under the HumanaChoice H5216-318 (PPO) plan. This benefit has a $35 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-318 (PPO) plan, with prior authorization required for all ambulance services. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance, and 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 under the HumanaChoice H5216-318 (PPO) plan. Emergency Services have a $140 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently Needed Services have a $65 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each have a $140 copay and no coinsurance.
Primary Care See details
The HumanaChoice H5216-318 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and physician specialist services with a $30 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $65.
Preventive Services See details
The HumanaChoice H5216-318 (PPO) plan covers preventive services with no copay for an annual physical exam. Other services like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and more 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; Prescription Hearing Aids (all types) have a copay between $699 and $999, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are covered, up to $50 every three months.
Vision Services See details
Vision services include eye exams with a copay between $0 and $30, and eyewear with no copay. Eyewear includes contact lenses and eyeglasses (lenses and frames) with a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $3,500 annual maximum benefit. Medicare Dental Services have a $30 copay, and other services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative Services and Prosthodontics, removable and fixed have 30-40% coinsurance, and Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance ranges from 0% to 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs also ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-318 (PPO) plan. There is a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by HumanaChoice H5216-318 (PPO). Durable Medical Equipment (DME) has no copay, and a coinsurance between 2% and 2%. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and a coinsurance between 10% and 20%, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay up to $65 and at least 20% coinsurance, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $360, Therapeutic Radiological Services with a copay from $30 to $40, and Outpatient X-Ray Services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-318 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-318 (PPO) plan with prior authorization required. For days 1-20, the copay is $20, and for days 21-100, the copay is $203; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The HumanaChoice H5216-318 (PPO) plan covers acupuncture with a $30 copay, up to 20 treatments per year, and also covers over-the-counter items, offering a $50 benefit every three months. This plan also provides a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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