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HumanaChoice H5216-325 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-325 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-325 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-325 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Louisiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-325 (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 H5216-325 (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 H5216-325 (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 $410.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 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 $5450.00 (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 $5450.00 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 H5216-325 (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible. After the deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay a $10 copay at preferred pharmacies or through mail order and a $20 copay at standard pharmacies. Standard generic drugs have a $47 copay, while preferred brand drugs have a 45% coinsurance. Non-preferred drugs have a 25% coinsurance.
Additional Benefits
The HumanaChoice H5216-325 (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services with varying copays. This plan covers primary care with no copay, along with hearing, vision, and dental services, each with their own specific cost-sharing structure. Emergency, ambulance, and transportation services are also covered, with specific copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by HumanaChoice H5216-325 (PPO). For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you pay a $115 copay for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services are covered. Outpatient hospital services have a copay of $0-$300, observation services have a $115 copay, and outpatient substance abuse services have a copay between $25-$75 depending on the session. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-325 (PPO) plan. 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 H5216-325 (PPO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $65 copay; both have 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 H5216-325 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $40 copay, mental health specialty services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $65, and opioid treatment program services with a copay between $25 and $75. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5216-325 (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, Kidney Disease Education Services, and other preventive services with no copay. Some additional preventive services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a $40 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered; all types of prescription hearing aids have a copay between $299 and $599 for two visits per year. OTC hearing aids are covered with a maximum benefit of $25 every three months.
Vision Services See details
The HumanaChoice H5216-325 (PPO) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $40 copay for Medicare dental services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice H5216-325 (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0-9%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 9% coinsurance and prior authorization required, Prosthetics/Medical Supplies with coinsurance for Medicare-covered items, and Diabetic Equipment with varying cost-sharing. Diabetic Supplies have 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $75, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a copay between $40 and $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-325 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-325 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5216-325 (PPO) plan, requiring prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The HumanaChoice H5216-325 (PPO) plan covers acupuncture with a $40 copay, up to 20 treatments per year, and also covers over-the-counter (OTC) items with a $25 maximum benefit every three months. This plan also covers meal benefits with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services or any of the listed additional services.
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