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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 $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $200.00 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 features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $10 copay for a one-month supply at standard pharmacies or no copay for a three-month supply when using preferred mail order. For brand-name and specialty medications, costs vary depending on the drug tier and supply. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with three-month supplies costing $141 at standard pharmacies or a reduced $131 through preferred mail order. Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply across standard pharmacies, standard mail order, and preferred mail order.
Additional Benefits
The Humana Value Choice H5216-318 (PPO) plan offers comprehensive medical coverage with clearly defined out-of-pocket costs, including no copays or coinsurance for primary care visits and preventive care. For hospital care, inpatient stays require a $340 daily copay for the first five days and no copay thereafter, while outpatient hospital services range from no copay up to a $300 copay. Specialist visits require a $30 copay, and emergency room visits are covered with a $150 copay, which is waived if you are admitted. This plan also includes valuable supplemental benefits, such as dental coverage up to a $5,000 annual limit with no copay or coinsurance for most preventive and comprehensive services. Routine vision and hearing exams are available with no copay, though prescription hearing aids and specialized eyewear require copayments. Additionally, members benefit from no copays on home health services and over-the-counter items, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Humana Value Choice H5216-318 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $340 daily copay for days 1 to 5 and no copay for days 6 to 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Humana Value Choice H5216-318 (PPO) are covered with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $300, observation services have a $340 copay per stay, and outpatient substance abuse sessions carry a $30 to $35 copay.
Partial Hospitalization See details
Humana Value Choice H5216-318 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Humana Value Choice H5216-318 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services to plan-approved or 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 have 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) features primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical, occupational, and speech therapies have a $35 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Humana Value Choice H5216-318 (PPO) with no copay and no coinsurance, which includes annual physical exams, kidney disease education, and specific screenings. Additional preventive benefits are partially covered, offering a memory fitness program with no copay or coinsurance, but excluding services like health education, weight management, and in-home safety assessments.
Hearing Services See details
Humana Value Choice H5216-318 (PPO) hearing services are partially covered with no coinsurance and no deductible. Routine exams and OTC hearing aids have no copay, Medicare-covered exams require a $30 copay, and prescription hearing aids require a $699 to $999 copay with inner ear, outer ear, and over-the-ear models not covered.
Vision Services See details
Vision services are partially covered by Humana Value Choice H5216-318 (PPO) with no deductible, no coinsurance, and copays ranging from $0 to $30 for exams and $0 for eyewear. The plan covers one routine eye exam (up to $75 annually) and one pair of eyeglasses or contact lenses (up to $100 annually), but other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Value Choice H5216-318 (PPO) partially covers dental services up to a $5,000 annual limit, with no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental requires a $30 copay and no coinsurance, prosthodontics require a 30% coinsurance and no copay, and fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Value Choice H5216-318 (PPO) with no copay, while associated Medicare Part B chemotherapy and other drugs require a coinsurance ranging from no coinsurance to 20%. Medicare Part B insulin is also covered with a $35 copay and a 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 durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Value Choice H5216-318 (PPO) covers diagnostic services with prior authorization, featuring a 20% coinsurance and up to a $65 copay for diagnostic procedures, and no copay for lab services. Covered radiological services also require prior authorization and have no coinsurance, offering no copay for X-rays and diagnostic radiology, and a copay starting at $30 for therapeutic radiology.
Home Health Services See details
Humana Value Choice H5216-318 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Value Choice H5216-318 (PPO) provides coverage for some cardiac rehabilitation services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These services require prior authorization and carry copayments ranging from $10 to $30.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-318 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary for admission, additional coverage beyond the standard 100 days is not covered.
Other Services See details
Humana Value Choice H5216-318 (PPO) partially covers other services, offering acupuncture with a $30 copay and no coinsurance for up to 20 treatments yearly, plus over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and some miscellaneous services are not covered.
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