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Humana Value Choice H5216-318 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Choice H5216-318 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Choice H5216-318 (PPO) in 2026, please refer to our full plan details page.
Humana Value Choice H5216-318 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in MO/IL/KS. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Choice 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 Humana Value Choice 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 Humana Value Choice 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 $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 $6300.00 (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 $6300.00 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 Humana Value Choice H5216-318 (PPO) prescription drug plan has an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs feature no copay for 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also cost-effective, offering no copay for a 3-month supply through preferred mail order and a $10 copay for a 1-month supply at standard pharmacies. For brand-name and specialty medications, Tier 3 preferred brand drugs cost a $47 copay for a 1-month supply at standard pharmacies and mail order. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Value Choice H5216-318 (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, physical therapies, and Medicare-covered dental services require a standard $30 copay with no coinsurance. For hospital stays, members pay a $375 daily copay for the first seven days of inpatient care, after which there is no copay. This plan also features strong ancillary benefits, including dental coverage up to $2,500 annually and routine vision exams with no copays or coinsurance. Routine hearing exams and over-the-counter hearing aids are also covered with no copay, while prescription hearing aids require copays ranging from $699 to $999. Additionally, skilled nursing facility stays require no coinsurance, with a daily copay of $10 for the first 20 days and $218 for days 21 through 100.
Inpatient Hospital See details
Humana Value Choice H5216-318 (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $375 daily copay for days 1 to 7 and no copay for days 8 and beyond, subject to prior authorization. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $334 daily copay for days 1 to 7 and no copay for days 8 to 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Value Choice H5216-318 (PPO) covers outpatient hospital services with a $0 to $300 copay and observation services with a $375 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a $30 to $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Value Choice H5216-318 (PPO) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Value Choice H5216-318 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Value Choice H5216-318 (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-318 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, mental health services, and physical, occupational, and speech therapies require a $30 copay and no coinsurance. Telehealth services range from a $0 to $65 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Value Choice H5216-318 (PPO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness benefit with no copay and no coinsurance, while services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Humana Value Choice H5216-318 (PPO) hearing services include Medicare-covered exams for a $30 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Humana Value Choice H5216-318 (PPO) with no deductible, no copays, and no coinsurance for covered care. Covered benefits include one routine eye exam (up to $75 annually) and one pair of contact lenses or eyeglasses (up to $100 annually), while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Value Choice H5216-318 (PPO) up to a yearly maximum of $2,500, with no copay and no coinsurance for most preventive, diagnostic, restorative, endodontic, and periodontic services. Medicare-covered dental services require a $30 copay and no coinsurance, prosthodontics require no copay and 30% coinsurance, and fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Value Choice H5216-318 (PPO) covers home infusion bundled services with no copay and no coinsurance, with prior authorization required. Medicare Part B chemotherapy and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Value Choice H5216-318 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Value Choice H5216-318 (PPO) covers medical equipment, requiring a 20% coinsurance and no copay for durable medical equipment (DME) and prosthetic devices, and a 15% coinsurance with no copay for medical supplies. Diabetic supplies have a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Value Choice H5216-318 (PPO) covers diagnostic procedures and tests with a 20% minimum coinsurance and copays ranging from no copay to $65, while lab services require coinsurance with no copay. Radiological services feature no coinsurance, offering outpatient X-rays and diagnostic radiology with no copay, and therapeutic radiology with a minimum copay of $30.
Home Health Services See details
Home Health Services are covered by Humana Value Choice H5216-318 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Humana Value Choice H5216-318 (PPO) with no copay and no coinsurance, though prior authorization is required. In practice, only some services are covered, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-318 (PPO) covers Skilled Nursing Facility (SNF) services 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 hospital stay is needed for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Value Choice H5216-318 (PPO) offers additional services including acupuncture for a $30.00 copay and no coinsurance, which is limited to 20 treatments per year and requires prior authorization. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, though the meal benefit requires prior authorization.
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