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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 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. 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 $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 $8400.00 (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 $8400.00 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 has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $9 copay for preferred generic drugs at a preferred pharmacy or via mail order. For standard generic drugs, you will pay a $47 copay at a standard pharmacy or via mail order. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-337 (PPO) plan offers a wide range of benefits with varying costs. You will pay a copay for inpatient hospital stays, outpatient services, emergency services, and primary care visits. This plan also includes benefits like no copay for preventive services, home health services, and routine eye exams, and offers coverage for hearing and dental services with copays. Additionally, you will pay coinsurance for medical equipment, dialysis, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-6, the copay is $295, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-337 (PPO) plan with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
For HumanaChoice H5216-337 (PPO), ambulance services are covered with a $315 copay for both ground and air ambulance services, but transportation services to health-related locations are not covered. There is no coinsurance for ambulance services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice H5216-337 (PPO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $55 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay. There is no coinsurance for any of these services.
Primary Care See details
The HumanaChoice H5216-337 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $40 copay, and mental health specialty services with a $35 copay. This plan also covers physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a $0-$55 copay, and opioid treatment program services with a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5216-337 (PPO) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services with a copay. Fitness benefits are covered with no copay, and Kidney Disease Education Services are covered with no copay. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams are covered by the HumanaChoice H5216-337 (PPO) plan with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a copay between $599 and $899, but hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5216-337 (PPO) plan covers vision services, including routine eye exams with a copay of $0 - $40 and eyewear with no copay. This plan's eyewear benefit includes contact lenses and eyeglasses (lenses and frames) with no copay, but does not cover eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
HumanaChoice H5216-337 (PPO) covers dental services, including a $40 copay for Medicare Dental Services, and no copay for 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. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $750 maximum plan benefit coverage amount per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a coinsurance that varies between 0% and 20% depending on the specific drug. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance that varies between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-337 (PPO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 15% coinsurance, Prosthetic Devices with 10% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HumanaChoice H5216-337 (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a copay between $35 and $40, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-337 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-337 (PPO), but the specific services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-337 (PPO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture and a meal benefit. Acupuncture has a $40 copay, and the meal benefit has no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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