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HumanaChoice H5216-346 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-346 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-346 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-346 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-346 (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 H5216-346 (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 H5216-346 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $2.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $350.00 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 $14000.00 (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 $14000.00 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 H5216-346 (PPO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you will pay a $12 copay at preferred pharmacies and a $20 copay at standard mail order pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your covered drugs.
Additional Benefits
The HumanaChoice H5216-346 (PPO) plan offers a range of benefits with varying costs. You can expect a $399 copay for inpatient hospital stays, and a $110 copay for emergency services. The plan covers primary care with a $15 copay, hearing exams with a $50 copay, and vision exams with a $0-$50 copay. Many preventive services are available with no copay, and dental services have a $50 copay for Medicare-covered services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $399 copay for days 1-6, and no copay for days 7-90, and no copay for days 91-999; Inpatient Hospital Psychiatric has a $399 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $450, Observation Services with a $399 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $45 and $100 for both Individual and Group Sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-346 (PPO) plan, with an $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-346 (PPO) covers ambulance services, including both ground and air ambulance services, each with a $315 copay and no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the HumanaChoice H5216-346 (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
The HumanaChoice H5216-346 (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician and chiropractic services have a $15 copay, occupational therapy services have a $25 copay, physician specialist services have a $50 copay, individual and group mental health and psychiatric sessions have a $45 copay, physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay between $0 and $50. The plan does not cover podiatry services.
Preventive Services See details
Preventive Services include a yearly physical exam with no copay, and other services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. Additional preventive services, including fitness benefits, are also covered, but the copay information is not provided. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The HumanaChoice H5216-346 (PPO) plan covers hearing exams with a $50 copay and routine hearing exams with no copay for one visit per year, as well as fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $699 and $999 for all types of prescription hearing aids. However, OTC hearing aids, prescription hearing aids for the inner ear, outer ear, and over-the-ear are not covered.
Vision Services See details
The HumanaChoice H5216-346 (PPO) plan covers vision services including eye exams with a copay of $0-$50. The plan also covers eyewear, including contact lenses and eyeglasses (lenses and frames) with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-346 (PPO) covers Medicare Dental Services with a $50 copay and offers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-346 (PPO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with a 10-20% coinsurance and a $0-$10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The HumanaChoice H5216-346 (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $120, and lab services with no copay. Outpatient X-ray services have a $15 copay, while diagnostic radiological services have a copay of at most $495. Therapeutic radiological services have a coinsurance of at least 20% and a copay of at least $50.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-346 (PPO) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
For HumanaChoice H5216-346 (PPO), Cardiac Rehabilitation Services are not covered, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5216-346 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice H5216-346 (PPO) plan covers acupuncture with a $50 copay and a limit of 20 treatments per year, and also covers a meal benefit with no copay. Other services such as over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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