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HumanaChoice H5216-326 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-326 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-326 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-326 (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 H5216-326 (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 H5216-326 (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 H5216-326 (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 $750.00 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 $6900.00 (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 $6900.00 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 H5216-326 (PPO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $10 copay for preferred generic drugs at a preferred pharmacy. For standard generic drugs, you will pay a $47 copay, while preferred brand drugs will cost you 40% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-326 (PPO) plan provides coverage for a wide array of services. This plan includes no copay for many services, such as primary care, preventive services, and vision and dental services. Other services have varying costs, including inpatient hospital stays with a copay, emergency services with a $125 copay, and ambulance services with a $315 copay. The plan also offers coverage for hearing services, home health, and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $295 copay for days 1-10, and no copay for days 11-90, with additional days 91-999 having no copay; non-Medicare covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has a $247 copay for days 1-10, and no copay for days 11-90, and additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services, with a $295 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay between $30 and $75 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-326 (PPO) plan. The copay for this benefit is $40. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-326 (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. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-326 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, and physician specialist services with a $35 copay. Mental health services have a copay of $30, physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits range from no copay to $55. Opioid treatment program services have a copay between $30 and $75. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5216-326 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, with specific sub-services such as Health Education, In-Home Safety Assessment, and others not covered.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5216-326 (PPO) plan covers vision services, including eye exams with a copay of $0-$35 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
The HumanaChoice H5216-326 (PPO) plan covers a variety of dental services, including 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, all with no copay. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $2,000 maximum plan benefit per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice H5216-326 (PPO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 19% for all other listed services.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-326 (PPO) plan and require prior authorization. The plan has a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Diabetic Equipment, is covered. DME has a 2% coinsurance and requires authorization, while Diabetic Supplies have a 10% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, and radiological services, are covered. 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 up to $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-326 (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
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, and prior authorization is required. There is a copay for some services, but the details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-326 (PPO) plan, with prior authorization required. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
Under the HumanaChoice H5216-326 (PPO) plan, acupuncture has a $35 copay, and a limit of 20 treatments per year, while the meal benefit has no copay. Other services such as over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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