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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 2025, 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 2025.
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.
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 $305.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $395.00 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) plan has a $395.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you'll pay $12.00 copay for preferred generic drugs at a standard or preferred mail pharmacy. For preferred brand drugs, you'll pay 37% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-383 (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, and coverage for outpatient services with varying copays. The plan also covers emergency services, primary care, preventive services, and home health services with no copays, as well as hearing, vision, and dental services with copays. Additional benefits include coverage for ambulance services with a copay, and services like partial hospitalization, home infusion, dialysis, and medical equipment with copays or coinsurance. Other services such as skilled nursing, cardiac rehabilitation, and acupuncture are covered, each with their own requirements for prior authorization and associated copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric care, with a copay of $420 for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute are covered with no copay for days 91-999, but non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient Hospital Services have a copay between $45 and $625, Observation Services have a $420 copay, and Ambulatory Surgical Center (ASC) Services have a $275 copay. Outpatient Substance Abuse Services, including individual and group sessions, have copays between $45 and $100, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-383 (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5216-383 (PPO) plan. Ground and Air Ambulance Services have a $315 copay, and there is no coinsurance, 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. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-383 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a $30 copay, mental health specialty services with a $45 copay, physical therapy and speech-language pathology services with a $40 copay, and telehealth services with a copay between $0 and $55.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and additional preventive services, including an annual physical exam with no copay. Other services like health education, in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
The HumanaChoice H5216-383 (PPO) plan covers Hearing Exams with a $30 copay, and Routine Hearing Exams with no copay. Fitting/Evaluation for Hearing Aids has no copay, and Prescription Hearing Aids (all types) are covered with a copay between $699 and $999 per year. Prescription Hearing Aids for the Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$30, and the plan covers routine eye exams with no copay. Eyewear is covered, including contact lenses and eyeglasses, each with no copay and a combined maximum of $100 per year, but eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-383 (PPO) plan covers various dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Medicare dental services have a $30 copay, and some services like fluoride treatment, restorative services, endodontics, and others are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5216-383 (PPO), including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-383 (PPO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 2% coinsurance, and Prosthetics/Medical Supplies with 2% coinsurance. Diabetic Supplies have a 2-10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $95, lab services with no copay, diagnostic radiological services with a copay between $30 and $350, therapeutic radiological services with a coinsurance of 20%, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-383 (PPO) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services like 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 are not covered. There is a copay for covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-383 (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
Other Services include acupuncture, meal benefits, and other services. Acupuncture has a $30 copay and requires prior authorization, while the plan covers up to 20 treatments per year. Meal benefits have no copay and require prior authorization. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others, are not covered.
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