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HumanaChoice H5216-383 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-383 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-383 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-383 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in DC. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-383 (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 H5216-383 (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 H5216-383 (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 $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $110.00 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 $7700.00 (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 $7700.00 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 H5216-383 (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members enjoy no copay for one-month and three-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a one-month supply at standard pharmacies and through preferred mail order, with no copay for a three-month supply ordered via preferred mail. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard pharmacies and mail order, with savings available on three-month supplies through preferred mail order for $131. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 37% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. Standard mail order options are also available across multiple tiers, though they typically carry higher copays than preferred mail order.
Additional Benefits
The HumanaChoice H5216-383 (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, members pay a $30 copay, while inpatient hospital stays require a $420 daily copay for the first five days and no copay for subsequent days. Emergency care is accessible worldwide with a $130 copay, which is waived upon hospital admission, and urgent care costs a $50 copay. This plan also features robust supplemental benefits, including routine dental, vision, and hearing exams with no copays or coinsurance. Members receive up to $250 annually for contacts or eyeglasses with no copay, and dental services generally feature no copay, though Medicare-covered dental requires a $30 copay. For specialized medical needs, diagnostic lab services and outpatient X-rays have no copay, while durable medical equipment requires an 18% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-383 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $420 copay per day for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-383 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $35 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay of $0 to $625, while observation services carry a $420 copay per stay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice H5216-383 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-383 (PPO) covers ground and air ambulance services with a $330 copay and no coinsurance, requiring prior authorization. Transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
HumanaChoice H5216-383 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-383 (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Most other covered services, including physical therapy and mental health sessions, require copays ranging from $0 to $40 with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services under HumanaChoice H5216-383 (PPO) are covered with no copays and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, featuring chemotherapy-related hair loss wigs (up to $500 annually with no copay or coinsurance) while excluding fitness benefits, health education, nutritional therapy, and in-home safety assessments.
Hearing Services See details
HumanaChoice H5216-383 (PPO) hearing services feature Medicare-covered exams for a $30 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices yearly, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-383 (PPO) partially covers vision services with no deductible and no coinsurance, offering one routine eye exam per year with no copay up to a $75 limit. One yearly pair of contact lenses or eyeglasses (lenses and frames) is covered with no copay up to a $250 limit, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-383 (PPO), which charges a $30.00 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-383 (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-383 (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5216-383 (PPO), with durable medical equipment (DME) requiring an 18% coinsurance and no copay. Prosthetic devices and medical supplies carry a 20% coinsurance with no copay, while diabetic supplies feature a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-383 (PPO), with prior authorization required. Lab services and outpatient X-rays have no copay or coinsurance, diagnostic procedures have a $0 to $95 copay with no coinsurance, diagnostic radiological services have a minimum $0 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-383 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-383 (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, although prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-383 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-383 (PPO) offers partial coverage for other services, including acupuncture with a $30 copay and no coinsurance for up to 20 treatments yearly, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
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