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HumanaChoice H5216-368 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-368 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-368 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-368 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Alabama. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-368 (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 H5216-368 (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 H5216-368 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.00. 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 $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 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 $6200.00 (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 $6200.00 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 H5216-368 (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $5 copay at preferred mail and standard pharmacies, and a $20 copay at standard mail pharmacies. For standard generic drugs, the copay is $47 at all pharmacies. For preferred brand drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 25% coinsurance.
Additional Benefits
The HumanaChoice H5216-368 (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll have no copay for primary care visits, preventive services, and routine hearing exams, and there are also copays for specialist visits, emergency services, and some therapies. The plan also covers vision and dental services, with no copay for eye exams and preventive dental care. Additionally, the plan covers home health services, and offers coverage for ambulance, hearing, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $225 copay for days 1-7, and no copay for days 8-90, while Additional Days for Inpatient Hospital-Acute has no copay for days 91-999; Inpatient Hospital Psychiatric has a $225 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the HumanaChoice H5216-368 (PPO) plan. Outpatient hospital services have a copay between $0 and $350, while observation services have a $225 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-368 (PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice H5216-368 (PPO). Ground Ambulance Services have a copay of $315, while Air Ambulance Services have a 20% coinsurance. 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 by the HumanaChoice H5216-368 (PPO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
The HumanaChoice H5216-368 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $20 copay. The plan also covers physician specialist services with a $40 copay, mental health specialty services and psychiatric services with a $40 copay, and physical therapy/speech-language pathology services with a $20 copay. Additionally, additional telehealth benefits are covered with a copay ranging from $0 to $40, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services includes Medicare-covered services with no copay, an annual physical exam with no copay, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing exams are covered with a $40 copay, while routine hearing exams are covered with no copay for one visit per year, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $699 for two visits per year, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5216-368 (PPO) plan covers vision services, including eye exams with a copay between $0 and $40, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-368 (PPO) plan covers dental services, including Medicare dental services with a $40 copay, and other dental services with a $1,500 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Restorative services and Prosthodontics, removable, and Prosthodontics, fixed have a 30-40% coinsurance and no copay. Fluoride treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the HumanaChoice H5216-368 (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $5 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, diagnostic procedures/tests (with a copay between $0 and $75), lab services (with no copay), and outpatient X-ray services (with no copay). Radiological services include a copay up to $325 for diagnostic services, a copay up to $40 and 20% coinsurance for therapeutic services, and coinsurance for X-ray services.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-368 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice H5216-368 (PPO) plan, but the plan does not cover any of the sub-services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-368 (PPO) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes acupuncture and a meal benefit. Acupuncture has a $40 copay per visit and is limited to 20 treatments per year. The meal benefit has 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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