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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 $5700.00 (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 $5700.00 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) plan features an annual prescription drug deductible of $420. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, featuring a $5 copay for a 1-month supply at standard pharmacies or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options. For higher-tier medications, Tier 4 non-preferred drugs carry a 48% coinsurance, while Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply. This structure provides clear cost-saving opportunities, especially when utilizing preferred mail order services for your generic prescriptions.
Additional Benefits
The HumanaChoice H5216-337 (PPO) plan offers comprehensive medical coverage with predictable costs, including no copay and no coinsurance for primary care visits and preventive services. Specialist visits are available for a $35 copay, while inpatient hospital stays require a $295 daily copay for the first five days and no copay for days six through 90. Emergency care is covered with a $130 copay, and urgent care visits require a $50 copay, both featuring no coinsurance. This plan also features robust supplemental benefits, including home health services and routine dental, vision, and hearing exams with no copay. Covered dental services feature no copay up to a $1,500 annual maximum, and routine vision care includes up to $250 annually for eyewear with no copay or deductible. Durable medical equipment is covered with a 20% coinsurance and no copay, while over-the-counter items are fully covered with no copay.
Inpatient Hospital See details
HumanaChoice H5216-337 (PPO) partially covers inpatient hospital care with no coinsurance, requiring a $295 daily copay for days 1 to 5 and no copay for days 6 to 90. While unlimited additional acute care days are covered with no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-337 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital copays range from $0 to $295, observation services require a $295 copay per stay, and outpatient substance abuse sessions carry a copay of $30 to $35.
Partial Hospitalization See details
HumanaChoice H5216-337 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these 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, though prior authorization is required. While transportation services are technically covered, trips to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-337 (PPO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-337 (PPO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Therapy services require a $40 copay with no coinsurance, while chiropractic care is partially covered at a $15 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-337 (PPO) provides preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and screenings for glaucoma and diabetes. Additional preventive services are partially covered, featuring a memory fitness benefit with no copay or coinsurance, though sub-services such as health education, weight management, nutritional benefits, in-home safety assessments, personal emergency response systems, medical nutrition therapy, in-home medication reconciliation, re-admission prevention, wigs, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice H5216-337 (PPO) covers Medicare-covered hearing exams with a $35 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Over-the-counter hearing aids are covered with no copay and no coinsurance, but prescription hearing aids are only partially covered—excluding inner ear, outer ear, and over the ear types—with a copay of $699 to $999 and no coinsurance.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-337 (PPO), featuring no copay, no coinsurance, and no deductible for covered services. This benefit includes one routine eye exam (up to $75 annually) and one pair of eyeglasses or contact lenses (up to $250 annually), while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-337 (PPO) offers partially covered dental services with an annual maximum limit of $1,500 for combined in- and out-of-network care. Covered diagnostic, preventive, and comprehensive services have no copay and no coinsurance, while Medicare-covered dental services require a $35 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
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. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-337 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
HumanaChoice H5216-337 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, subject to prior authorization. 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, offering lab, diagnostic radiology, and outpatient X-ray services with no copay but subject to coinsurance. Diagnostic procedures and tests carry a $0 to $50 copay and 20% coinsurance, while therapeutic radiological services require a minimum $35 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-337 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-337 (PPO) covers some Cardiac Rehabilitation Services with no coinsurance and required prior authorization, though Cardiac Rehabilitation ($10 copay), Intensive Cardiac Rehabilitation ($10 copay), Pulmonary Rehabilitation ($15 copay), and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) (no copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-337 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the HumanaChoice H5216-337 (PPO) are partially covered, featuring acupuncture for a $35 copay and no coinsurance, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay and no coinsurance, while Dual Eligible SNPs with Highly Integrated Services and other miscellaneous services are not covered.
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