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HumanaChoice H5216-347 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-347 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-347 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-347 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Georgia and South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-347 (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 H5216-347 (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 H5216-347 (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 $1.00. 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 $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 $10100.00 (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 $10100.00 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 H5216-347 (PPO) Medicare plan features an annual drug deductible of $350. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a 1-month supply and offering no copay for a 3-month supply through preferred mail order. For Tier 3 preferred brand drugs, members pay a $47 copay for a 1-month supply at standard pharmacies and mail order services. Tier 4 non-preferred drugs require a 50% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty medications carry a 29% coinsurance for a 1-month supply at standard pharmacies and through mail order.
Additional Benefits
The HumanaChoice H5216-347 (PPO) plan offers affordable access to essential medical services, featuring no copay and no coinsurance for primary care visits, preventive screenings, and home health care. Specialist visits require a low $15 copay, while inpatient hospital stays cost a $345 daily copay for the first eight days of acute stays with no coinsurance. Emergency medical care is covered with a $130 copay, which is waived upon hospital admission, and urgent care visits require a $50 copay. For supplemental health needs, this plan provides robust dental, vision, and hearing benefits, including routine eye exams and eyewear with no copay up to a $350 limit. Preventive dental care is also covered with no copay up to a $2,500 annual limit, while routine hearing exams feature no copay and prescription hearing aids require a copay between $99 and $399. Lastly, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5216-347 (PPO) covers inpatient hospital services with no coinsurance, requiring a $345 daily copay for days 1 to 8 of acute stays (with no copay for days 9 and beyond) and a $345 daily copay for days 1 to 6 of psychiatric stays (with no copay for days 7 to 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-347 (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay between $0 and $450, while outpatient substance abuse sessions cost a $35 copay and outpatient observation services require a $345 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-347 (PPO) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HumanaChoice H5216-347 (PPO) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, which require prior authorization. However, transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-347 (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 with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services require a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-347 (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Under this plan, physical, occupational, and speech therapies have a $25 copay with no coinsurance, and mental health services carry a $35 copay with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under HumanaChoice H5216-347 (PPO), featuring annual physical exams, kidney disease education, and screenings with no copay and no coinsurance. While a memory fitness benefit is also covered with no copay and no coinsurance, other supplemental services like health education, in-home safety assessments, PERS, medical nutrition therapy, and weight management are not covered.
Hearing Services See details
HumanaChoice H5216-347 (PPO) covers hearing services, featuring Medicare-covered exams for a $15 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with a $99 to $399 copay and no coinsurance for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-347 (PPO) vision services are partially covered, offering one routine eye exam and eyewear (eyeglasses or contact lenses) per year with no copay, no coinsurance, and no deductible up to a $350 combined limit. Other eye exams, separate lenses or frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
HumanaChoice H5216-347 (PPO) partially covers dental services up to a $2,500 annual limit, with a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-347 (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and up to 20% coinsurance (with a minimum of no coinsurance), while chemotherapy and other Part B drugs have no copay and up to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-347 (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-347 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. 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 H5216-347 (PPO), offering lab services with no copay or coinsurance, and diagnostic procedures with a $0 to $120 copay and no coinsurance. Outpatient X-rays feature no copay but require coinsurance, while therapeutic radiological services require at least a $15 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-347 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-347 (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-347 (PPO) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior 3-day hospital stay is not needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-347 (PPO) provides partially covered other services, which include acupuncture for a $15 copay and no coinsurance (up to 20 treatments per year) and chronic illness meals with no copay and no coinsurance. Over-the-Counter (OTC) items are not covered under this plan.
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