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Humana Full Access H5216-333 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-333 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5216-333 (PPO) in 2026, please refer to our full plan details page.
Humana Full Access H5216-333 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Full Access H5216-333 (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 Full Access H5216-333 (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 Full Access H5216-333 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $94.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $400.00 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 $3800.00 (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 $3800.00 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 Full Access H5216-333 (PPO) plan features a $400 annual prescription drug deductible. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order, while standard mail order costs up to a $30 copay for a 3-month supply. Tier 2 generic drugs are also highly affordable, with no copay for a 3-month supply via preferred mail order and an $8 copay for a 1-month supply at standard pharmacies. For Tier 3 preferred brand drugs, copays are $47 for a 1-month supply, with savings available on 3-month supplies through preferred mail order for a $94 copay. Higher-tier medications require coinsurance instead of copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance across all pharmacy options. Tier 5 specialty drugs require 28% coinsurance for a 1-month supply at standard pharmacies and mail order services.
Additional Benefits
The Humana Full Access H5216-333 (PPO) plan offers affordable healthcare coverage, featuring no copay for primary care doctor visits and a $40 copay for specialists. For hospital care, inpatient stays require a $325 daily copay for days 1 through 6 and no copay for days 7 through 90, while emergency room visits carry a $115 copay that is waived if you are admitted. Outpatient surgery and diagnostic lab services are also highly accessible, requiring no copay. This plan also provides strong supplemental coverage, including routine dental, vision, and hearing exams with no copay, alongside a generous $1,750 annual dental benefit limit. Home health services are fully covered with no copay or coinsurance, while skilled nursing facilities require no copay for the first 20 days. Additionally, durable medical equipment is covered with no copay and a 15% coinsurance.
Inpatient Hospital See details
Humana Full Access H5216-333 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute hospital days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Full Access H5216-333 (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay between $0.00 and $325.00, and outpatient substance abuse sessions have a copay of $25.00 to $35.00.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Full Access H5216-333 (PPO) plan with a $35 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Full Access H5216-333 (PPO) partially covers ambulance and transportation services, offering ground ambulance services for a $335 copay and air ambulance services for a $630 copay, with no coinsurance required for either. However, transportation services to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
Humana Full Access H5216-333 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Full Access H5216-333 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Other covered benefits include physical and occupational therapy for a $35 copay, mental health services for a $25 copay, and podiatry for a $35 to $40 copay, all with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Humana Full Access H5216-333 (PPO) provides partially covered preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and home-based palliative care.
Hearing Services See details
Hearing services offered by Humana Full Access H5216-333 (PPO) are partially covered, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine annual exams and fitting evaluations. Prescription hearing aids require a copay of $699 to $999 with no coinsurance for up to two devices per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Humana Full Access H5216-333 (PPO) plan, offering one routine eye exam and select eyewear per year with no copay and no coinsurance. Covered eyewear (contacts or eyeglasses) has a combined $100 annual limit and exams have a $75 annual limit, but other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Full Access H5216-333 (PPO) offers partially covered dental services with an annual maximum benefit of $1,750, requiring a $40 copay and no coinsurance for Medicare-covered dental and no copay or coinsurance for other covered services. While most preventive and comprehensive services are covered, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Full Access H5216-333 (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Full Access H5216-333 (PPO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Humana Full Access H5216-333 (PPO), featuring a 15% coinsurance and no copay for durable medical equipment (DME) and medical supplies. Prosthetic devices require a 20% coinsurance with no copay, while diabetic supplies have a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts carry a $10 copay.
Diagnostic and Radiological Services See details
Humana Full Access H5216-333 (PPO) covers diagnostic and radiological services with prior authorization, featuring no copay for lab services and outpatient X-rays. Diagnostic procedures carry no coinsurance with copays ranging from $0 to $100, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $20 copay.
Home Health Services See details
Home Health Services are covered under the Humana Full Access H5216-333 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Full Access H5216-333 (PPO) does not cover cardiac rehabilitation services. This includes no coverage for intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Humana Full Access H5216-333 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $218 copay for days 21 through 100, with no coverage available for additional days.
Other Services See details
Humana Full Access H5216-333 (PPO) partially covers other services, offering acupuncture for a $40 copay and no coinsurance 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 benefit.
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