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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 2026, 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 2026.
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 $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 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 $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 an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $5 for a 1-month supply at standard pharmacies, and you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, while a 3-month supply costs $131 through preferred mail order and $141 at standard pharmacies. For higher-tier medications, you will pay coinsurance instead of a flat copay. Tier 4 non-preferred drugs require a 48% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H5216-326 (PPO) plan offers affordable medical coverage with no copay or coinsurance for primary care visits, home health services, and annual preventive physicals. Specialist visits and outpatient mental health services require a $35 copay with no coinsurance, while physical therapy has a $30 copay. For inpatient acute hospital stays, members pay no coinsurance and a $295 daily copay for days one through ten, with no copay for additional days. Supplemental benefits include routine vision and hearing exams with no copay, alongside a $1,500 annual limit for dental care that features no copay for preventive services. Emergency care is available with a $130 copay, while ground ambulance transportation has a $335 copay and no coinsurance. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5216-326 (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring prior authorization for stays. Acute care requires a $295 daily copay for days 1 to 10 and no copay for additional days, while psychiatric care costs a $247 daily copay for days 1 to 10 and no copay for days 11 to 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-326 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services have a copay of $0 to $350, observation services carry a $295 copay per stay, and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-326 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-326 (PPO) covers ambulance services with a $335 copay and no coinsurance for ground transportation, and a 20% coinsurance with no copay for air transportation, with prior authorization required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-326 (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-326 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and psychiatric services require a $35 copay and no coinsurance. Physical, occupational, and speech therapy are covered with a $30 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice H5216-326 (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, and diabetes training. This benefit is partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered. Covered supplemental benefits include in-home support, smoking cessation, and memory fitness, all available with no copay and no coinsurance.
Hearing Services See details
HumanaChoice H5216-326 (PPO) offers partially covered hearing services, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Up to two prescription hearing aids are covered per year with no coinsurance and copays ranging from $599 to $899, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-326 (PPO) with no coinsurance, offering routine eye exams with no copay and a $150 annual limit for eyewear with no copay. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-326 (PPO) up to a $1,500 annual limit, featuring no copay and no coinsurance for preventive care, and a $35 copay with no coinsurance for Medicare-covered services. Covered comprehensive services require no copay and 0% to 40% coinsurance, while fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-326 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-326 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
HumanaChoice H5216-326 (PPO) covers medical equipment with a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are available with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-326 (PPO), with prior authorization required for these benefits. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $75 copay for procedures, while radiological services range from no copay for X-rays to a minimum $35 copay and 20% coinsurance for therapeutic radiology.
Home Health Services See details
HumanaChoice H5216-326 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HumanaChoice H5216-326 (PPO) with no coinsurance and a $15 copay, subject to prior authorization. However, only some services are covered in practice, and standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-326 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. Members pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-326 (PPO) provides partial coverage for other services, including acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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