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Humana Value Plus H5216-382 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5216-382 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Plus H5216-382 (PPO) in 2026, please refer to our full plan details page.
Humana Value Plus H5216-382 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Michigan. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Plus H5216-382 (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 Value Plus H5216-382 (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 Value Plus H5216-382 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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 $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 $13900.00 (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 $13900.00 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 Value Plus H5216-382 (PPO) plan features an annual drug deductible of $250 and offers cost-effective coverage for common medications. For Tier 1 preferred generics, there is no copay for 1-month or 3-month supplies at standard pharmacies or through preferred mail order. Tier 2 generic drugs carry a low $5 copay for a 1-month supply at standard pharmacies, and there is no copay for a 3-month supply when filled via preferred mail order. For brand-name and specialty medications, the plan transitions to higher copays and coinsurance rates. Tier 3 preferred brand drugs cost a $47 copay for a 1-month supply, with a slightly reduced cost of $131 for a 3-month supply through preferred mail order. Tier 4 non-preferred drugs require a 42% coinsurance, while Tier 5 specialty drugs carry a 30% coinsurance for a 1-month supply.
Additional Benefits
The Humana Value Plus H5216-382 (PPO) plan offers balanced medical coverage with clear cost-sharing structures for essential services. Inpatient hospital stays require a $2,185 copay per stay for acute care with no coinsurance, while primary care and specialist visits have no copay and a 20% coinsurance. Emergency room visits carry a $110 copay, and outpatient hospital services range from no copay to a $35 copay with 20% coinsurance. For everyday wellness, the plan features no copay and no coinsurance for key preventive services, home health care, and select dental care up to a $1,000 annual limit. Routine vision and hearing exams are available with no copay and a 20% coinsurance, alongside covered eyewear and prescription hearing aids with no copay. Skilled nursing facility care is also accessible, requiring no copay for the first 20 days.
Inpatient Hospital See details
Humana Value Plus H5216-382 (PPO) partially covers inpatient hospital services, featuring a $2,185 copay per stay and no coinsurance for acute care, and a $2,036 copay per stay and no coinsurance for psychiatric care. While unlimited additional days for acute stays are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Humana Value Plus H5216-382 (PPO) include outpatient hospital services with a $0 to $35 copay and 20% coinsurance, and ambulatory surgical center visits with no copay and 20% coinsurance. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Value Plus H5216-382 (PPO) with a $35 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Value Plus H5216-382 (PPO) covers ground and air ambulance services with a $315 copay and no coinsurance. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Humana Value Plus H5216-382 (PPO) covers emergency services with a $110 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $110 copay and no coinsurance, with no deductibles applying to any of these benefits.
Primary Care See details
Humana Value Plus H5216-382 (PPO) covers primary care, specialist, and physical therapy services with no copay and a 20% coinsurance, while mental health, psychiatric, and opioid treatment services require a $35 copay and no coinsurance. Telehealth options range from a $0 to $40 copay with 20% coinsurance, but podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by Humana Value Plus H5216-382 (PPO) with no copay and no coinsurance for key benefits like annual physical exams, glaucoma screenings, and diabetes training. The benefit is partially covered as it excludes services such as health education, weight management, nutritional benefits, and in-home support, but it does cover memory fitness, smoking cessation, and chemotherapy wigs up to $500 annually with no copay and no coinsurance.
Hearing Services See details
Humana Value Plus H5216-382 (PPO) hearing services are partially covered, offering Medicare-covered exams, fitting evaluations, and OTC hearing aids with no copays and no coinsurance. Routine exams are covered once annually with no copay and a 20% coinsurance, while up to two prescription hearing aids are covered every three years with no copay or coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Value Plus H5216-382 (PPO) vision services are partially covered, featuring routine eye exams with no copay and 20% coinsurance, alongside eyewear with no copay and no coinsurance. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
Humana Value Plus H5216-382 (PPO) offers dental services with no copay and no coinsurance for most preventive and comprehensive care up to a $1,000 annual limit, while Medicare-covered dental services have no copay and a 20% coinsurance. This benefit is partially covered, as fluoride treatments, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Value Plus H5216-382 (PPO) covers home infusion bundled services, with prior authorization and step therapy required. Covered Medicare Part B insulin requires a $35 copay and up to 20% coinsurance, other Part B drugs have no copay and up to 20% coinsurance, and chemotherapy or radiation drugs carry a copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Value Plus H5216-382 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Value Plus H5216-382 (PPO) covers medical equipment with no copays, though prior authorization is required for most items. Durable medical equipment carries an 18% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and manufacturer-limited diabetic supplies carry a 10% to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Value Plus H5216-382 (PPO) subject to prior authorization and a 20% coinsurance. Lab services and diagnostic radiological services require no copay, while diagnostic tests range from no copay to $40, and outpatient X-rays carry a $40 copay.
Home Health Services See details
Home Health Services are covered by the Humana Value Plus H5216-382 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Humana Value Plus H5216-382 (PPO) plan with no copay and require prior authorization. However, most specific rehabilitation services—including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD)—are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Value Plus H5216-382 (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and does not require a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with prior authorization required and no coverage for additional days beyond the Medicare limit.
Other Services See details
Humana Value Plus H5216-382 (PPO) partially covers other services, offering acupuncture with no copay and 20% coinsurance, as well as over-the-counter items and meal benefits with no copay and no coinsurance. Highly integrated services for dual-eligible SNPs are not covered under this plan.
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