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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 2026, 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 Arkansas and Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $420.00 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:
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Drug Coverage
The HumanaChoice H5216-337 (PPO) prescription drug plan features an annual drug deductible of $420. For Tier 1 preferred generic drugs, members enjoy no copay for one-month or three-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly budget-friendly, requiring just a $5 copay for a one-month supply, or no copay for a three-month supply when filled via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply, or a reduced $131 copay for a three-month supply through preferred mail order. Higher-tier medications are subject to coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 48% coinsurance. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply across standard pharmacies and mail-order options.
Additional Benefits
The HumanaChoice H5216-337 (PPO) Medicare plan offers comprehensive coverage for essential medical needs, featuring no copay or coinsurance for primary care visits and annual preventive exams. Specialist visits require a $40 copay, while inpatient hospital stays carry a $295 daily copay for the first five days and no copay for days 6 through 90. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Routine dental, vision, and hearing services are highly affordable, offering routine exams, cleanings, and over-the-counter hearing aids with no copay. Durable medical equipment is covered with an 18% coinsurance and no copay, while home health services are provided with no copay or coinsurance. Additionally, the plan includes valuable extra benefits like over-the-counter items and chronic illness meals at no copay.
Inpatient Hospital See details
HumanaChoice H5216-337 (PPO) covers inpatient hospital stays with no coinsurance, requiring a $295 copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because additional psychiatric days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-337 (PPO) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $295, alongside a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 to $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice H5216-337 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
HumanaChoice H5216-337 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. For transportation services, some services are covered, but transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
HumanaChoice H5216-337 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-337 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Most other covered benefits require no coinsurance, including physical and occupational therapy for a $35 copay, mental health sessions for a $30 copay, and telehealth for a $0 to $50 copay, though podiatry is not covered, and while some chiropractic services are covered for a $15 copay, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice H5216-337 (PPO), offering annual physical exams, kidney disease education, and screenings with no copay and no coinsurance. Additional services such as fitness benefits, health education, weight management programs, and personal emergency response systems are not covered.
Hearing Services See details
HumanaChoice H5216-337 (PPO) covers routine hearing exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. OTC hearing aids are covered with no copay or coinsurance, and prescription hearing aids are partially covered with a $499 to $799 copay and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over-the-ear models.
Vision Services See details
HumanaChoice H5216-337 (PPO) partially covers vision services with no coinsurance or deductibles, offering routine eye exams with no copay (other eye exams have a $0 to $40 copay up to a $75 annual limit) and eyewear with no copay up to a $250 annual combined limit. Covered eyewear includes one annual pair of contact lenses or eyeglasses (lenses and frames), while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-337 (PPO), with no coverage for fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance up to a $1,500 annual limit.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5216-337 (PPO) with no copay, though prior authorization is required. Related Medicare Part B drugs, including chemotherapy, carry a 0% to 20% coinsurance, while covered insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-337 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
HumanaChoice H5216-337 (PPO) covers durable medical equipment (DME) with an 18% coinsurance and no copay, and prosthetics and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-337 (PPO) covers diagnostic and radiological services with prior authorization, featuring no copay for lab services, diagnostic radiology, and outpatient x-rays, though coinsurance applies to lab and x-ray services. Diagnostic procedures and tests have a $0 to $50 copay and 20% coinsurance, while therapeutic radiological services require a minimum $40 copay and 20% coinsurance.
Home Health Services See details
Home health services are covered by HumanaChoice H5216-337 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-337 (PPO) with no coinsurance and a $10 copay, with prior authorization required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by HumanaChoice H5216-337 (PPO) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
HumanaChoice H5216-337 (PPO) provides partially covered other services, featuring acupuncture with a $40 copay and no coinsurance for up to 20 treatments yearly, alongside chronic illness meal benefits and over-the-counter items available with no copay and no coinsurance. Other services, including dual-eligible SNP benefits and other unspecified supplemental benefits, are not covered under this plan.
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