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Humana Full Access H5216-378 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-378 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5216-378 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access H5216-378 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Northwest Indiana Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Full Access H5216-378 (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 Full Access H5216-378 (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 Full Access H5216-378 (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 $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $530.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $250.00 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 $4150.00 (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 $4150.00 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 Full Access H5216-378 (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $5 copay at preferred mail order pharmacies and $5 at standard pharmacies. For standard generic drugs, the copay is $47.00 at all pharmacies. Preferred brand drugs have a 50% coinsurance, and non-preferred drugs have a 30% coinsurance.
Additional Benefits
The Humana Full Access H5216-378 (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find no copay for primary care visits, routine hearing exams, vision eyewear, and many dental and preventive services. However, you will encounter copays for services like specialist visits, ambulance services, and some therapies.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $400 for days 1-6 and no copay for days 7-90 for both. Additional days for Inpatient Hospital-Acute have no copay for days 91-999, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $495, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $35 and $80 for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, but requires prior authorization. You will have a $60 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Full Access H5216-378 (PPO) plan. Ground and air ambulance services have a $315 copay, while 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 under the Humana Full Access H5216-378 (PPO) plan. Emergency Services have a $120 copay, and Urgently Needed Services have a $65 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Full Access H5216-378 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $55 copay. It also covers physician specialist services with a $35 copay, mental health specialty services with a minimum $35 copay, and physical therapy and speech-language pathology services with a $55 copay. Additional telehealth benefits are covered with a copay between $0 and $65, and opioid treatment program services are covered with a minimum copay of $35.
Preventive Services See details
The Humana Full Access H5216-378 (PPO) plan covers preventive services, including an annual physical exam with no copay. Some additional preventive services are not covered, including health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a Welcome Visit, all with no copay.
Hearing Services See details
The Humana Full Access H5216-378 (PPO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999, while inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with a copay between $0 and $35, and eyewear with no copay. However, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $35 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. However, fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Full Access H5216-378 (PPO) plan, with a coinsurance that varies between 0% and 20% depending on the specific drug. Insulin drugs have a $35 copay, and a coinsurance that varies between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Full Access H5216-378 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered under the Humana Full Access H5216-378 (PPO) plan, including Durable Medical Equipment with 5% coinsurance, Prosthetics/Medical Supplies with 5% coinsurance, and Diabetic Equipment. Diabetic Supplies have a coinsurance between 10-20% and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered, including diagnostic procedures and tests with a copay ranging from $0 to $105, and lab services with no copay. Radiological services are also covered, with a copay for diagnostic services up to $720 and a copay up to $30, and 20% coinsurance for therapeutic services. Outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5216-378 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. A copay is required, and prior authorization is needed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, with a copay of $20 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The Humana Full Access H5216-378 (PPO) plan covers acupuncture with a $35 copay and a limit of 20 treatments per year. The plan also covers a meal benefit with no copay, and some additional services such as Over-the-Counter (OTC) 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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