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HumanaChoice H5216-339 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-339 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-339 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-339 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in New Mexico. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-339 (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 H5216-339 (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 H5216-339 (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 $3.00. 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 $615.00 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 $6300.00 (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 $6300.00 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 H5216-339 (PPO) Medicare plan features an annual prescription drug deductible of $615. 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, starting at an $8 copay for a 1-month supply at standard pharmacies, with no copay for a 3-month supply filled via 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 47% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. This structure provides clear cost-saving opportunities, particularly when utilizing preferred mail order services for your medications.
Additional Benefits
The HumanaChoice H5216-339 (PPO) plan offers comprehensive medical coverage with no copay for primary care physician visits, home health services, and cardiac rehabilitation. Specialist visits require a $45 copay, while inpatient hospital stays have a $330 daily copay for the first six days and no copay for days 7 through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted within 24 hours, and urgently needed care is available for a $50 copay. For specialized care, the plan features a $2,500 annual maximum for dental services with no copay for most preventive and comprehensive care, alongside no copay for routine vision and hearing exams. Diagnostic lab services and outpatient X-rays also have no copay, while durable medical equipment requires a 15% coinsurance and dialysis services require a 20% coinsurance. Skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice H5216-339 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $330 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, though psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-339 (PPO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $325 copay ($330 per stay for observation services), and outpatient substance abuse services carry a $25 to $35 copay per session, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization benefits are covered under HumanaChoice H5216-339 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-339 (PPO) covers ambulance services with no coinsurance, requiring a $335 copay for ground transport and a $630 copay for air transport, with prior authorization required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-339 (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 under a $50 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-339 (PPO) primary care physician services feature no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, as routine and other chiropractic services are not covered, while other services like therapy and mental health range from no copay to a $45 copay with no coinsurance.
Preventive Services See details
HumanaChoice H5216-339 (PPO) preventive services are partially covered with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, and memory fitness. Uncovered services under this benefit include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-339 (PPO) hearing services include routine hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance for up to two aids per year, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-339 (PPO) with no coinsurance, offering no copay for routine exams, contact lenses, and eyeglasses, and up to a $45 copay for other exams. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-339 (PPO) covers dental services with an annual maximum benefit of $2,500, offering most preventive and comprehensive care with no copay and no coinsurance. Medicare-covered dental services require a $45 copay and no coinsurance, prosthodontics require no copay and a 30% coinsurance, and fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-339 (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-339 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-339 (PPO) covers medical equipment, including durable medical equipment (DME) and medical supplies with a 15% coinsurance and no copay. Prosthetic devices are covered with a 20% coinsurance and no copay, while diabetic supplies range from 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H5216-339 (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and no coinsurance. Diagnostic tests and radiological services feature no coinsurance and copays starting at $0 (up to $100 for tests), while therapeutic radiological services require a minimum 20% coinsurance and a copay of at least $40.
Home Health Services See details
HumanaChoice H5216-339 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the HumanaChoice H5216-339 (PPO) plan, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice H5216-339 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard 100-day limit are not covered.
Other Services See details
HumanaChoice H5216-339 (PPO) provides partially covered other services, including acupuncture for a $45 copay and no coinsurance, limited to 20 treatments per year with prior authorization. Over-the-counter items and chronic illness meal benefits are covered with no copay and no coinsurance, though prior authorization is required for meals and certain other services are not covered.
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