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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 $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) Medicare plan features an Enhanced Alternative drug benefit with a prescription drug deductible of $420.00. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generics cost a $5.00 copay at standard pharmacies and preferred mail, while Tier 2 standard generics require a $47.00 copay. For higher tiers, you will pay a coinsurance of 48% for Tier 3 preferred brand drugs and 28% for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy (LIS) full extra help will have no copay for their Part D coverage. To ensure your specific medications are covered, always check the plan's formulary before enrolling.
Additional Benefits
The HumanaChoice H5216-337 (PPO) plan offers comprehensive coverage for essential medical care, featuring no copay for primary care visits, home health services, and annual preventive exams. For inpatient hospital stays, members pay a daily copay of $295 for days 1 through 6 and no copay for days 7 through 90. Emergency room visits carry a $130 copay, which is waived upon admission, while specialist office visits require a $35 copay. Supplemental benefits like routine dental, vision, and hearing exams are available with no copays, alongside generous allowances like $1,000 for dental care and $250 for eyewear. Outpatient services are covered with no deductibles and varying copays, whereas durable medical equipment and dialysis services require a 20% coinsurance. Skilled nursing facility stays are also covered, requiring a $10 copay for days 1 through 20 and a $218 copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice H5216-337 (PPO) partially covers inpatient hospital benefits, requiring a daily copay of $295 for days 1 through 6, no copay for days 7 through 90, and no coinsurance. Sub-services that are not covered under this plan include non-Medicare-covered stays, inpatient acute upgrades, and additional days for psychiatric hospital stays.
Outpatient Services See details
HumanaChoice H5216-337 (PPO) covers outpatient services with no coinsurance and no deductibles. Copays range from $0 to $350 for outpatient hospital services, $295 per stay for observation services, and $30 to $35 for substance abuse sessions, while ambulatory surgical center and blood services require no copay.
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 access these covered benefits.
Ambulance and Transportation Services See details
HumanaChoice H5216-337 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-337 (PPO) for a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are available for 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
Primary Care benefits are partially covered by HumanaChoice H5216-337 (PPO), as podiatry and routine chiropractic services are not covered. Covered services include primary care visits with no copay and no coinsurance, specialist visits for a $35 copay, and various therapy and mental health services with copays ranging from $25 to $35 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by HumanaChoice H5216-337 (PPO) with no copay and no coinsurance for covered options like annual physical exams, memory fitness, and kidney disease education. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-337 (PPO) covers routine hearing exams, fitting evaluations, and OTC hearing aids with no copay or coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with a $599 to $899 copay and no coinsurance for general types, but inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
HumanaChoice H5216-337 (PPO) provides partially covered vision services with no deductibles, no coinsurance, and copays ranging from $0 to $35 for eye exams and no copay for eyewear. While routine exams, contact lenses, and eyeglasses are covered up to annual limits of $75 for exams and $250 for eyewear, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-337 (PPO), offering most preventive and comprehensive care with no copay or coinsurance up to a $1,000 annual maximum, while Medicare-covered dental services require a $35 copay and no coinsurance. Fluoride treatment, 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), subject to prior authorization and step therapy. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no 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 to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-337 (PPO) covers durable medical equipment (DME) with a 20% coinsurance and no copay, and prosthetic devices with a 20% coinsurance. 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
Diagnostic and radiological services are covered by HumanaChoice H5216-337 (PPO) with prior authorization. Lab services and outpatient X-rays have no copay and no coinsurance, while diagnostic tests require a $0 to $100 copay and no coinsurance. Diagnostic radiological services feature a copay of up to $360 with no coinsurance, and therapeutic radiological services require a 20% coinsurance and a copay of up to $35.
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 not covered under the HumanaChoice H5216-337 (PPO) plan. None of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by HumanaChoice H5216-337 (PPO) with prior authorization, requiring a $10 copay for days 1-20, a $218 copay for days 21-100, and no coinsurance. This benefit is partially covered, as additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-337 (PPO) provides partially covered other services, featuring acupuncture for a $35 copay and no coinsurance up to 20 treatments per year, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
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