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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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan has a $330.00 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'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, a standard generic drug has a $47 copay, while preferred brand drugs have 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered 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 with varying cost-sharing. This plan includes coverage for inpatient hospital stays, outpatient services, emergency care, primary care, preventive services, hearing, vision, and dental services. The plan also covers a range of other services like home health, skilled nursing, and medical equipment, with specific copays, coinsurance, and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $360 copay for days 1-5, and no copay for days 6-90, while additional days have no copay.
Outpatient Services See details
The HumanaChoice H5216-318 (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $400, observation services with a $360 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $40 copay for individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-318 (PPO) plan, with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a 20% 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 under the HumanaChoice H5216-318 (PPO) plan. Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a $65 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all 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 with a $35 copay, and physician specialist services with a $30 copay. Mental health specialty services and psychiatric services have a $30 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $65, and opioid treatment program services have a $40 copay.
Preventive Services See details
The HumanaChoice H5216-318 (PPO) plan covers a range of preventive services. Annual physical exams have no copay, while additional preventive services are covered, though some services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams are covered with no copay for one visit every year. Fitting/Evaluation for Hearing Aids is covered with no copay. Prescription Hearing Aids are partially covered, 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, with a maximum benefit of $50 every three months.
Vision Services See details
The HumanaChoice H5216-318 (PPO) plan covers vision services, including eye exams with a copay between $0 and $30, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-318 (PPO) plan covers Medicare Dental Services with a $30 copay, and other dental services with a $2,000 maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Restorative Services and Prosthodontics (removable and fixed) have no copay, with 30-40% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The cost sharing for Medicare Part B Insulin Drugs includes a $35 copay with a coinsurance between 0% and 20%; other services have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-318 (PPO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 5% coinsurance, while Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10%-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
For HumanaChoice H5216-318 (PPO), Diagnostic and Radiological Services include coverage for all diagnostic services and all radiological services. Diagnostic Procedures/Tests have a copay of up to $65 and at least 20% coinsurance, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $360, Therapeutic Radiological Services have a copay of up to $40, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-318 (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 H5216-318 (PPO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-318 (PPO) plan. For days 1-20, there is a $20 copay, and for days 21-100, the copay is $203; additional days beyond Medicare-covered SNF stays 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 up to $50 every three months. The plan also provides a meal benefit with no copay, and some other services are covered, while others are not.
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