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HumanaChoice H5216-376 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-376 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-376 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-376 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Maryland. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-376 (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 H5216-376 (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 H5216-376 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $9.40. 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 $500.00 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 $12900.00 (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 $12900.00 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 H5216-376 (PPO) prescription drug plan has an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay for both 1-month and 3-month supplies at standard pharmacies and mail-order services. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, and you pay no copay for a 3-month supply filled through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, while a 3-month supply costs $131 through preferred mail order and $141 through standard pharmacies or standard mail order. Tier 4 non-preferred drugs require a 40% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply across all standard pharmacy and mail-order options.
Additional Benefits
The HumanaChoice H5216-376 (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and routine dental, vision, and hearing exams. For specialized care, members pay a $45 copay for specialist visits and a daily copay of $407 for the first six days of acute inpatient hospital stays, with no copay for subsequent days. Outpatient services feature no coinsurance, with no copay for ambulatory surgical centers and variable copays up to $975 for outpatient hospital services. Emergency care is accessible with a $115 copay and no coinsurance, which is waived upon hospital admission, while urgent care visits require a $40 copay. Skilled nursing facility care requires no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Additionally, durable medical equipment is covered with no copay and a 17% coinsurance, and home health services are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-376 (PPO) inpatient hospital care is partially covered with no coinsurance, requiring prior authorization for all stays. Acute hospitalizations require a $407 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays require a $345 daily copay for days 1 through 6 and no copay for days 7 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-376 (PPO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $975, observation services carry a $407 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-376 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-376 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-376 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services each require a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under the HumanaChoice H5216-376 (PPO) plan feature no copay and no coinsurance for primary care provider visits, while specialist visits require a $45 copay with no coinsurance. Additional services like therapy, telehealth, and mental health care have copays ranging from no copay to $45 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-376 (PPO) preventive services are partially covered with no copay and no coinsurance for services like annual physical exams, kidney disease education, and chemotherapy wigs up to $500. However, multiple supplemental services are not covered, including fitness benefits, weight management programs, health education, and in-home safety assessments.
Hearing Services See details
HumanaChoice H5216-376 (PPO) hearing services are partially covered, featuring routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Up to two prescription hearing aids are covered annually with copays between $699 and $999 and no coinsurance, though OTC hearing aids and specific inner, outer, and over-the-ear models are not covered.
Vision Services See details
HumanaChoice H5216-376 (PPO) provides partially covered vision services with no deductibles and no coinsurance, featuring one annual routine eye exam with no copay up to a $75 limit, though other eye exams are not covered. Eyewear is also partially covered with no copay up to a combined $200 annual limit for contact lenses and complete eyeglasses, while individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-376 (PPO) dental services are partially covered, offering preventive and comprehensive care—including exams, cleanings, and X-rays—with no copay and no coinsurance, while Medicare-covered dental services require a $45 copay and no coinsurance. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-376 (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance of 0% to 20%, while Part B insulin drugs require a $35 copay with 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under HumanaChoice H5216-376 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-376 (PPO) covers durable medical equipment (DME) with a 17% coinsurance and no copay, and 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 or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-376 (PPO) covers diagnostic and radiological services, offering lab services with no copay and no coinsurance, and diagnostic tests with a $0 to $95 copay and no coinsurance. Diagnostic radiological services feature no coinsurance and copays starting at $0, outpatient X-rays require no copay with coinsurance, and therapeutic services carry a minimum $45 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-376 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are provided by HumanaChoice H5216-376 (PPO) with no coinsurance, though only some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered. These services require prior authorization and carry copays ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by HumanaChoice H5216-376 (PPO) 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, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5216-376 (PPO), featuring acupuncture with a $45 copay and no coinsurance for up to 20 treatments per year, alongside chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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