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HumanaChoice H5216-389 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-389 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-389 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-389 (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 H5216-389 (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 H5216-389 (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 H5216-389 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $300.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $300.00 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 $9750.00 (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 $9750.00 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 H5216-389 (PPO) plan has a $300 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 will pay $15 for preferred generic drugs at a standard or mail-order pharmacy. You will pay 38% coinsurance for preferred brand drugs at any pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-389 (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care physician visits and routine eye exams, and preventive services like an annual physical exam are also covered with no copay. The plan includes coverage for hearing and vision services, and dental services, each with some copays. Additionally, the plan provides benefits for ambulance and emergency services, home health services, and skilled nursing facilities, each with their own copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, you pay a $415 copay, and for days 6-90, there is no copay; additional days 91-999 have no copay.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $800, observation services with a $415 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $40 and $90 for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-389 (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HumanaChoice H5216-389 (PPO) plan, with a $315 copay for both ground and air ambulance services, and 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 under the HumanaChoice H5216-389 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice H5216-389 (PPO) plan covers Primary Care Physician services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20-$40 copay, and Physician Specialist Services with a $25 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40-$40 copay for individual sessions and a $40-$40 copay for group sessions. Physical Therapy and Speech-Language Pathology Services have a $20-$40 copay, and Additional Telehealth Benefits range from no copay to a $55 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered zero dollar services, an annual physical exam with no copay, and additional preventive services that require prior authorization. This plan covers wigs for hair loss related to chemotherapy, with no copay and a maximum benefit of $500 per year. Other covered services include kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a copay between $699 and $999, while OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $25, and routine eye exams with no copay, both of which are covered once per year. Eyewear is covered with no copay and a combined maximum of $100 every year, while contact lenses and eyeglasses (lenses and frames) are covered with no copay once per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-389 (PPO) covers a range of dental services. Medicare Dental Services and Restorative Services have a $25 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Adjunctive General Services have no copay. However, Fluoride Treatment, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The cost for Medicare Part B Insulin Drugs includes a $35 copay and between 0% and 20% coinsurance, while the cost for other drugs includes between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-389 (PPO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 11% coinsurance, Prosthetics/Medical Supplies with 11% coinsurance, and Diabetic Equipment, including Diabetic Supplies with 10-10% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered, with a minimum copay of $0 for diagnostic procedures/tests and lab services, and no copay for outpatient X-ray services. Diagnostic Radiological Services have a copay of at most $325, and Therapeutic Radiological Services have a coinsurance of at least 20% and a copay of at least $25.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-389 (PPO) with no copay and no coinsurance, although additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for PAD Services are not covered. This benefit requires prior authorization.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-389 (PPO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for acupuncture with a $25 copay, and a meal benefit with no copay, but over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Acupuncture treatments are limited to 20 per year.
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