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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 2025, 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 2025.
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 $20.90. 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 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 $14000.00 (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 $14000.00 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 has a $250 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you may pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy. For preferred brand drugs, you'll pay 42% coinsurance, and for non-preferred drugs, you'll pay 30% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Humana Value Plus H5216-382 (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance depending on the service. Emergency, primary care, and preventive services are covered, often with no copay, and include hearing, vision, and dental services with varying cost-sharing. This plan also provides coverage for home health services, skilled nursing facilities, and medical equipment, with some services requiring prior authorization. Additionally, the plan covers ambulance and transportation services, home infusion, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits for the Humana Value Plus H5216-382 (PPO) plan cover Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but the plan does not cover Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric. The copay for Inpatient Hospital-Acute is $2,185 per admission or stay, and the copay for Inpatient Hospital Psychiatric is $2,036 per admission or stay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance and a copay between $0 and $100, Observation Services with a $500 copay, Ambulatory Surgical Center (ASC) Services with a 20% coinsurance and no copay, Outpatient Substance Abuse Services with a 20% coinsurance and a $100 copay, and Outpatient Blood Services with no copay. Individual and Group Sessions for Outpatient Substance Abuse also have a 20% coinsurance and a $100 copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $315 copay. Transportation services to a plan-approved health-related location are also covered, with no copay for up to 24 one-way trips per year, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are all covered. Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, and Urgently Needed Services has a $45 copay; all have no coinsurance.
Primary Care See details
The Humana Value Plus H5216-382 (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Most services have a 20% coinsurance, while additional telehealth benefits have a copay between $0 and $45, and opioid treatment program services have a copay of $100.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services such as wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, and a fitness benefit, all with no copay. Other services like health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams, including routine hearing exams, are covered with at most 20% coinsurance, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered up to $500 per ear per year, and OTC hearing aids are covered with no copay up to $575 per ear per year. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Value Plus H5216-382 (PPO) plan's dental services include coverage for Medicare dental services with 20% coinsurance, and other dental services up to a $1,000 annual maximum. Oral exams, dental x-rays, other diagnostic services, cleaning, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery are covered with no copay. However, fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, and no copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Value Plus H5216-382 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by the Humana Value Plus H5216-382 (PPO) plan. Durable Medical Equipment (DME) has an 18% coinsurance, and no copay, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a maximum copay of $45 and a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a maximum copay of $325 and a coinsurance of at most 20%, and Outpatient X-Ray Services have a $45 copay and a coinsurance of at most 20%. Therapeutic Radiological Services have a coinsurance of at most 20%.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Value Plus H5216-382 (PPO) plan, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Value Plus H5216-382 (PPO) plan, with no copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Value Plus H5216-382 (PPO) plan covers acupuncture with a 20% coinsurance, and up to 20 treatments per year, as well as over-the-counter (OTC) items, with a maximum benefit of $75 every three months. The plan also offers a meal benefit with no copay for a chronic illness. However, this plan does not cover several other services including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others.
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