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HumanaChoice H5216-353 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-353 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-353 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-353 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in El Paso County. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-353 (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 H5216-353 (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 H5216-353 (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 $340.00 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 $9550.00 (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 $9550.00 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 H5216-353 (PPO) prescription drug plan features an annual drug deductible of $340. 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, costing as low as a $9 copay for a 1-month supply at standard pharmacies, or no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at standard pharmacies or through preferred mail order. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring 45% coinsurance and Tier 5 specialty drugs requiring 29% coinsurance.
Additional Benefits
The HumanaChoice H5216-353 (PPO) plan provides comprehensive coverage for essential medical services, featuring no copay for primary care doctor visits and no coinsurance for inpatient hospital stays, which carry a $245 daily copay for the first five days. Outpatient services, diagnostic lab tests, and home health care are also available with no copay, while specialist visits require a $30 copay. Emergency room care has a $130 copay, which is waived if you are admitted to the hospital, and urgent care visits require a $50 copay. This plan also includes valuable supplemental benefits, offering no copay for routine dental, vision, and hearing exams. You can take advantage of a $2,500 annual maximum for covered dental services, a $300 yearly allowance for eyewear, and up to 48 free one-way trips to plan-approved locations. Additionally, members pay no copay for over-the-counter items, chronic illness meals, and over-the-counter hearing aids.
Inpatient Hospital See details
HumanaChoice H5216-353 (PPO) covers inpatient hospital services with no coinsurance, requiring a $245 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered because prior authorization is required, and room upgrades, non-Medicare-covered stays, and additional psychiatric days beyond day 90 are not covered.
Outpatient Services See details
HumanaChoice H5216-353 (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services carry a copay of $0 to $275, observation services have a $245 copay per stay, and outpatient substance abuse sessions require a $30 to $35 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice H5216-353 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice H5216-353 (PPO), featuring a $335 copay and no coinsurance for ground ambulance services, and a 20% coinsurance and no copay for air ambulance services. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice H5216-353 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay 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 are covered with a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits under HumanaChoice H5216-353 (PPO) include primary care physician services with no copay and no coinsurance, and specialist and therapy visits with a $30 copay and no coinsurance. Chiropractic services are partially covered, offering routine care for a $15 copay and no coinsurance (other chiropractic services are not covered), while podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-353 (PPO) preventive services are partially covered with no copayments and no coinsurance for annual exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and a memory fitness benefit. Non-covered services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Hearing services are covered by HumanaChoice H5216-353 (PPO) with no deductible, featuring a $30 copay and no coinsurance for Medicare-covered exams, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $299 to $599 and no coinsurance for up to two aids annually—excluding inner ear, outer ear, and over-the-ear types—while unlimited over-the-counter hearing aids are available with no copay and no coinsurance.
Vision Services See details
HumanaChoice H5216-353 (PPO) partially covers vision services with no deductible, no coinsurance, and no copays for covered routine eye exams and eyewear. This benefit includes one routine exam and up to a $300 annual allowance for contact lenses or eyeglasses (lenses and frames) per year, but other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-353 (PPO), with Medicare-covered dental requiring a $30 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance up to a $2,500 annual maximum. Fluoride treatments, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-353 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while covered Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-353 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
HumanaChoice H5216-353 (PPO) covers medical equipment, including 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
HumanaChoice H5216-353 (PPO) covers diagnostic and radiological services, featuring no coinsurance for all diagnostic services, which include no copay for lab services and a $0 to $50 copay for diagnostic procedures. Diagnostic radiological services and outpatient X-rays are covered with no copay, while therapeutic radiological services require a $40 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-353 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-353 (PPO) offers cardiac rehabilitation services with no coinsurance and prior authorization, but some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-353 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5216-353 (PPO), which offers acupuncture for a $30 copay and no coinsurance, and both over-the-counter items and chronic illness meals with no copay and no coinsurance. Certain other supplemental services and dual eligible SNP benefits are not covered.
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