A non-government entity
HumanaChoice H5216-337 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-337 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-337 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-337 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-337 (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 H5216-337 (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 H5216-337 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $250.00 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 $8950.00 (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 $8950.00 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:
Sign up for HumanaChoice H5216-337 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5216-337 (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you can expect to pay a $9 copay for preferred generic drugs at a preferred pharmacy, while standard generic drugs have a $47 copay. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-337 (PPO) plan offers a range of benefits with varying costs. It covers inpatient hospital stays with a copay, outpatient services with copays ranging from $0-$295, and emergency services with a $125 copay. Primary care visits have a $5 copay, and specialist visits have a $40 copay, while preventive services like annual physical exams have no copay. Hearing exams have a $40 copay, and vision services include eye exams with a $0-$40 copay. Dental services, including oral exams and cleanings, have a $0 copay, while other dental services have a $40 copay. The plan also covers home health services, with no copay, and skilled nursing facility stays, with a copay depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 5 days of Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stays, there is a $295 copay, and days 6-90 have no copay, while additional days for Inpatient Hospital-Acute have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $295, and for observation services, with a $295 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-337 (PPO) plan, but requires prior authorization. You will have a $40 copay for this service.
Ambulance and Transportation Services See details
HumanaChoice H5216-337 (PPO) covers ambulance services, with a $315 copay for both ground and air ambulance services, and no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, while Urgently Needed Services have a $55 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-337 (PPO) plan covers primary care physician services with a $5 copay and chiropractic services with a $20 copay, but routine chiropractic care is not covered. Occupational therapy services have a $35 copay, while physician specialist services have a $40 copay. Mental health specialty services, psychiatric services, and opioid treatment program services also have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay between $0 and $55.
Preventive Services See details
The HumanaChoice H5216-337 (PPO) plan covers preventive services, including an annual physical exam with no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are also covered with no copay. However, health education, in-home safety assessments, and other additional preventive services are not covered.
Hearing Services See details
The HumanaChoice H5216-337 (PPO) plan covers hearing exams with a $40 copay. Routine hearing exams are covered with no copay for one exam every year. Fitting/evaluation for hearing aids has no copay and is unlimited. Prescription hearing aids are partially covered, but not for inner ear, outer ear, or over the ear aids. OTC hearing aids are covered up to $40 every three months.
Vision Services See details
The HumanaChoice H5216-337 (PPO) plan covers vision services, including eye exams with a copay of $0-$40 and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-337 (PPO) covers Medicare Dental Services with a $40 copay, and other dental services. 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 are covered with a $0 copay, and 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 H5216-337 (PPO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%, while other Medicare Part B drugs including Chemotherapy/Radiation drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-337 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and requires authorization, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered, with 10-20% coinsurance for Diabetic Supplies and 0% copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
The HumanaChoice H5216-337 (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a coinsurance of at most 20% and a copay of up to $60. Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $315, while Therapeutic Radiological Services have a copay of up to $50. Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-337 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-337 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for covered Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-337 (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, 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 H5216-337 (PPO) plan covers acupuncture with a $40 copay, and a limit of 20 treatments per year. Over-the-counter items are covered with a $40 maximum benefit every three months, including nicotine replacement therapy and Naloxone coverage, and unused amounts carry forward. The plan also covers a meal benefit with no copay. However, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved