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Humana Value Choice H5216-352 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Choice H5216-352 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Choice H5216-352 (PPO) in 2026, please refer to our full plan details page.
Humana Value Choice H5216-352 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Dallas and East Texas Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Choice H5216-352 (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 Humana Value Choice H5216-352 (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 Humana Value Choice H5216-352 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $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 Humana Value Choice H5216-352 (PPO) Medicare prescription drug plan features an annual drug deductible of $420. 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 medications cost as low as a $9 copay for a 1-month supply, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand-name drugs carry a $45 copay for a 1-month supply at standard pharmacies and through preferred mail order. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 48% coinsurance across standard pharmacy and mail order services. Tier 5 specialty drugs require 28% coinsurance for a 1-month supply at standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The Humana Value Choice H5216-352 (PPO) plan offers robust coverage with no copays for primary care doctor visits, preventive care, annual routine vision and hearing exams, and home health services. For specialist visits, physical therapy, and partial hospitalization, members will pay predictable copayments ranging from $25 to $35 with no coinsurance. Inpatient hospital stays require a $310 daily copay for the first six days with no copay thereafter, while emergency services are covered with a $130 copay. This plan also features dental coverage up to a $2,500 annual limit with no copays for most services, alongside no-copay benefits for over-the-counter items and acupuncture. For durable medical equipment and dialysis, members are responsible for an 18% to 20% coinsurance with no copay. These benefits combine to offer comprehensive medical and lifestyle support with minimal out-of-pocket expenses for key healthcare services.
Inpatient Hospital See details
Humana Value Choice H5216-352 (PPO) covers inpatient hospital services with no coinsurance, requiring a $310 daily copay for days 1 to 6 and no copay for days 7 to 90 for both acute and psychiatric stays. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, while unlimited additional acute days are covered with no copay.
Outpatient Services See details
Humana Value Choice H5216-352 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient substance abuse sessions require a $30 to $35 copay, while outpatient hospital and observation services carry a copay ranging from $0 to $350.
Partial Hospitalization See details
Humana Value Choice H5216-352 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Humana Value Choice H5216-352 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground ambulance, and a 20% coinsurance and no copay for air ambulance. While transportation services are technically covered, some services are not covered in practice, specifically transportation to plan-approved or any health-related locations.
Emergency Services See details
Emergency services are covered by Humana Value Choice H5216-352 (PPO) with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-352 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapies are covered with a $25 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Value Choice H5216-352 (PPO) offers preventive services with no copay and no coinsurance, covering annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, and a fitness benefit. Additional preventive services are only partially covered, as the plan excludes benefits such as health education, weight management programs, nutritional/dietary services, and in-home safety assessments.
Hearing Services See details
Humana Value Choice H5216-352 (PPO) covers hearing services with no copay and no coinsurance for annual routine exams, fittings, and OTC hearing aids, while Medicare-covered exams require a $30 copay and no coinsurance. Prescription hearing aids are partially covered with a $199 to $499 copay and no coinsurance for up to two devices yearly, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Humana Value Choice H5216-352 (PPO) vision services are partially covered, offering one annual routine eye exam and one pair of eyeglasses or contact lenses per year with no copay, no coinsurance, and no deductible. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
Humana Value Choice H5216-352 (PPO) partially covers dental services up to a $2,500 annual limit for both in- and out-of-network care, offering Medicare-covered dental with a $30 copay and no coinsurance, and other covered services with no copay and no coinsurance. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Value Choice H5216-352 (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B insulin drugs carry a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy and other Part B drugs require no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Value Choice H5216-352 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Value Choice H5216-352 (PPO) covers durable medical equipment (DME) with an 18% coinsurance and no copay, and prosthetic devices 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 Humana Value Choice H5216-352 (PPO) with no coinsurance and no copay for lab services, while other diagnostic tests carry a copay of $0 to $175. Outpatient X-rays have no copay, diagnostic radiology has a minimum copay of $0, and therapeutic radiological services require a minimum 20% coinsurance and a minimum $45 copay.
Home Health Services See details
Home Health Services are covered by Humana Value Choice H5216-352 (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 Humana Value Choice H5216-352 (PPO) plan, as none of the individual sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-352 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Value Choice H5216-352 (PPO) partially covers other services, offering acupuncture, over-the-counter (OTC) items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture (limited to 12 treatments per year) and meal benefits, while other additional services are not covered.
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