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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 2025, 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 2025.
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 $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 $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 H5216-347 (PPO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay a $5 copay at a standard or preferred mail-order pharmacy, and $20 at a standard mail-order pharmacy. Standard generic drugs have a $47 copay, while preferred and non-preferred brand drugs have 43% and 28% coinsurance, respectively. After 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 H5216-347 (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $450. Emergency services have a copay, and primary care physician visits have no copay. Preventive services, including an annual physical exam, have no copay. Hearing exams and routine hearing exams have no copay, with a copay for hearing aids. Vision services include eye exams and eyewear with no copay. Dental services are covered with no copay, up to an annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits, including those not usually covered by Medicare, are covered with prior authorization. For Inpatient Hospital-Acute, the copay is $399 for days 1-6, and no copay for days 7-90; additional days have no copay. For Inpatient Hospital Psychiatric, the copay is $399 for days 1-5, and no copay for days 6-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by HumanaChoice H5216-347 (PPO). Outpatient Hospital Services have a copay between $0 and $450, Observation Services have a $399 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay between $45 and $100, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-347 (PPO) plan and requires prior authorization. You will have an $80 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice H5216-347 (PPO). Ground and Air Ambulance Services have a $315 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice H5216-347 (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, and Occupational Therapy Services with a $25 copay. Physician Specialist Services have a $30 copay, while Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $45 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $25 copay, and Additional Telehealth Benefits have a copay between $0-$45. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, with services such as health education, in-home safety assessment, and others not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $30 copay. Routine hearing exams are covered for one visit per year with no copay, while fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899 for two visits per year, but prescription 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 H5216-347 (PPO) plan covers eye exams with a copay between $0 and $30, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum benefit for both in-network and out-of-network services. 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 are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and coinsurance between 0-20% for Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-347 (PPO) plan and require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
The HumanaChoice H5216-347 (PPO) plan covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the HumanaChoice H5216-347 (PPO) plan, with a maximum copay of $120 for Diagnostic Procedures/Tests and no copay for Lab Services and Outpatient X-Ray Services. Diagnostic Radiological Services have a maximum copay of $325 and Therapeutic Radiological Services have a maximum copay of $30 with a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-347 (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, but the plan does not cover any of the specific sub-services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-347 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The HumanaChoice H5216-347 (PPO) plan covers acupuncture with a $30 copay and a limit of 20 treatments per year. The plan also covers a meal benefit with 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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