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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 2026, 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 2026.
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 $20.00. 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 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 $615.00 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) Medicare plan features an Enhanced Alternative prescription drug benefit with an annual drug deductible of $615.00. During the initial coverage stage, standard pharmacy costs include a $5.00 copay for preferred generics and a $47.00 copay for standard generics. For higher-tier medications, members pay a 50% coinsurance for preferred brand drugs and a 25% coinsurance for non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy, also known as Extra Help, will pay $20.00 for Part D.
Additional Benefits
The HumanaChoice H5216-368 (PPO) plan offers robust coverage for essential medical services, featuring no copay for primary care visits and routine preventive services. For specialized care, members pay copays ranging from $20 to $40 for specialists, while emergency room visits carry a $150 copay that is waived if admitted. Inpatient hospital stays require a $225 daily copay for the first seven days of acute stays, after which there is no copay or coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,000 annual limit and routine vision exams with no copay. Routine hearing exams are also covered with no copay, and prescription hearing aids are available with copays ranging from $399 to $699. Additionally, home health services require no copay, while durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5216-368 (PPO) partially covers inpatient hospital services, requiring a $225 copay for days 1 to 7 of acute stays and days 1 to 6 of psychiatric stays, with no copay for remaining days and no coinsurance. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-368 (PPO) covers outpatient services with no coinsurance, featuring a copay of up to $325 for outpatient hospital services and a $225 copay per stay for observation services. Outpatient substance abuse sessions require a $35 copay, while ambulatory surgical center and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by HumanaChoice H5216-368 (PPO) with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-368 (PPO) partially covers Ambulance and Transportation Services, as transportation services to both plan-approved and any health-related locations are not covered. Covered ground ambulance services require a $335 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for both.
Emergency Services See details
HumanaChoice H5216-368 (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered for a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for a $150 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by HumanaChoice H5216-368 (PPO), as podiatry services and routine chiropractic care are not covered. Covered services require no coinsurance, featuring no copay for primary care visits and copays ranging from $20 to $40 for specialists and therapy, and up to $65 for telehealth.
Preventive Services See details
HumanaChoice H5216-368 (PPO) partially covers preventive services with no copay or coinsurance for annual exams, fitness benefits, in-home support, kidney education, and select screenings. However, sub-services including health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-368 (PPO), offering annual routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $40 copay and no coinsurance. Prescription hearing aids (all types) are covered up to two per year with a $399 to $699 copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by HumanaChoice H5216-368 (PPO), offering one routine eye exam per year with no copay or coinsurance, up to a $40 annual limit. Eyewear is partially covered with no copay or coinsurance up to a $300 annual limit for contact lenses and complete eyeglasses (lenses and frames), but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-368 (PPO) offers partially covered dental services with a $2,000 annual limit for both in- and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered services like oral exams, cleanings, and restorative care have no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-368 (PPO) covers Home Infusion bundled Services, which require prior authorization. Covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-368 (PPO) plan with a 20% coinsurance and no copay, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-368 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance, with no copay required for durable medical equipment. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts have a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-368 (PPO) covers diagnostic and radiological services, with prior authorization required. Outpatient X-rays and lab services carry no copay and no coinsurance, diagnostic procedures require a $0 to $75 copay and no coinsurance, diagnostic radiology requires a $0 to $335 copay and no coinsurance, and therapeutic radiology requires a $40 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-368 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5216-368 (PPO) plan, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by HumanaChoice H5216-368 (PPO), featuring no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under HumanaChoice H5216-368 (PPO), offering acupuncture with a $40 copay and no coinsurance, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items and Dual Eligible SNPs with Highly Integrated Services are not covered.
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