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Humana Full Access H5216-384 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-384 (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 H5216-384 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access H5216-384 (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 Full Access H5216-384 (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 H5216-384 (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 H5216-384 (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 $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 $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 $5900.00 (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 $5900.00 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 H5216-384 (PPO) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you may pay a $5 copay for preferred generic drugs at a preferred or mail-order pharmacy, but 46% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Full Access H5216-384 (PPO) plan offers a range of benefits with varying costs. You can expect no copay for primary care, preventive services, home health, and outpatient X-rays. This plan also covers inpatient hospital stays, emergency services, vision, dental, hearing, and more, with copays and coinsurance depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you'll pay a $440 copay for days 1-6, and no copay for days 7-90; additional days 91-999 have no copay. Inpatient psychiatric care has a $440 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $440, Observation Services with a $440 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services have a copay between $40 and $100 for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Full Access H5216-384 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Full Access H5216-384 (PPO) plan. Ground and Air Ambulance Services have a copay of $315, with no coinsurance. 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 by the Humana Full Access H5216-384 (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Under the Humana Full Access H5216-384 (PPO) plan, primary care physician services have no copay, and chiropractic services have a $20 copay. Occupational therapy services have a copay between $20 and $40, physician specialist services have a $40 copay, and mental health specialty services have a $40 copay for individual and group sessions.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services with a copay for some services. This plan also covers wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, and a fitness benefit with no copay.
Hearing Services See details
Hearing services are covered by the Humana Full Access H5216-384 (PPO) plan, including hearing exams with a $40 copay and routine hearing exams with no copay. Prescription hearing aids are partially covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, while OTC hearing aids are covered with a maximum benefit of $60 every three months.
Vision Services See details
Vision Services include eye exams with a copay of $0-$40, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Full Access H5216-384 (PPO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics, fixed with a maximum plan benefit of $2000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics, fixed have no copay and a 30-40% coinsurance. Fluoride treatment, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Full Access H5216-384 (PPO) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Full Access H5216-384 (PPO) plan and require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is also covered, with a coinsurance and copay that varies depending on the service, including a 10-20% coinsurance and no copay for Diabetic Supplies, and a $10 copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and all radiological services. For Diagnostic Procedures/Tests, there is a copay between $0 and $105, and Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $720, while Therapeutic Radiological Services have a maximum 20% coinsurance and a maximum copay of $40. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5216-384 (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 the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Full Access H5216-384 (PPO), but require prior authorization. You will have a copay of $10 for days 1-20, and a copay of $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $40 copay and requires prior authorization, while the meal benefit has no copay and also requires prior authorization. OTC items are covered with a maximum plan benefit coverage amount of $60 every three months. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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