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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 2026, 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 2026.
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 $1000.00 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 $10100.00 (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 $10100.00 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) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies, but you can pay no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail-order services. Higher-tier medications, such as Tier 4 non-preferred drugs, carry a 47% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. Understanding these tier copays and coinsurance rates will help you estimate your out-of-pocket prescription expenses.
Additional Benefits
The HumanaChoice H5216-325 (PPO) plan offers comprehensive medical coverage with low out-of-pocket costs, featuring no copays for primary care physician visits, preventive exams, and home health services. For specialized medical needs, specialist visits require a $40 copay, while inpatient hospital stays carry a $115 daily copay for the first 10 days and no copay thereafter. Outpatient hospital services are also highly affordable, with copays ranging from no copay up to $275 and no coinsurance. This Medicare Advantage plan also provides robust dental, vision, and hearing benefits to support your overall well-being. Dental services are covered up to a $2,000 annual maximum with no copays for most routine care, and vision services include an annual routine exam plus a $350 eyewear allowance with no copay or deductible. Additionally, members benefit from no copays on routine hearing exams and affordable copays ranging from $299 to $599 for prescription hearing aids.
Inpatient Hospital See details
HumanaChoice H5216-325 (PPO) covers inpatient hospital services with no coinsurance, requiring a $115 copay for days 1 through 10 and no copay for days 11 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric stay days are not covered.
Outpatient Services See details
Outpatient services under HumanaChoice H5216-325 (PPO) are covered with no coinsurance, featuring copays of $0 to $275 for outpatient hospital services and $115 per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-325 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-325 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-325 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay per service and no coinsurance.
Primary Care See details
HumanaChoice H5216-325 (PPO) offers primary care physician visits with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, and mental health therapies have copays ranging from $30 to $35 with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-325 (PPO) preventive services are partially covered, offering annual physical exams, kidney education, glaucoma screenings, diabetes training, fitness benefits, and in-home support with no copay and no coinsurance. Multiple supplemental services are not covered under this plan, including health education, nutritional therapy, personal emergency response systems, weight management programs, and home safety assessments.
Hearing Services See details
HumanaChoice H5216-325 (PPO) offers partially covered hearing services with no coinsurance, featuring no copay for an annual routine exam or fitting evaluations, and a $40 copay for Medicare-covered exams. Covered prescription hearing aids (limit of two per year) require a copay between $299 and $599 with no coinsurance, while OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-325 (PPO), featuring one annual routine eye exam and a $350 yearly allowance for contact lenses or eyeglasses (lenses and frames) with no deductible, no copay, and no coinsurance. Other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-325 (PPO) partially covers dental services up to a $2,000 annual maximum, offering no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental requires a $40 copay and no coinsurance, prosthodontics require no copay and a 30% coinsurance, while fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5216-325 (PPO) with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-325 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-325 (PPO) with prior authorization, including durable medical equipment (DME) at a 12% coinsurance with no copay, and prosthetics and medical supplies at a 20% coinsurance with no copay. Diabetic supplies feature a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay, subject to manufacturer limitations.
Diagnostic and Radiological Services See details
HumanaChoice H5216-325 (PPO) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic procedures carry a copay of $0 to $75 with no coinsurance, and therapeutic radiological services require a minimum $40 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-325 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-325 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, specific programs including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-325 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay, although prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare limit.
Other Services See details
Other Services are partially covered under the HumanaChoice H5216-325 (PPO) plan, featuring acupuncture for a $40 copay and no coinsurance (up to 20 treatments per year) and chronic illness meals with no copay and no coinsurance. Over-the-Counter (OTC) items are not covered.
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