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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 2026, 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 2026.
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 $16.20. 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 $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 $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 features an annual prescription drug deductible of $615. For Tier 1 preferred generics, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications cost as low as a $5 copay for a 1-month supply, and you will pay no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with a 3-month supply costing up to $141 depending on the pharmacy service. Tier 4 non-preferred drugs require a 42% coinsurance, while Tier 5 specialty tier drugs carry a 25% coinsurance. These rates help you understand your out-of-pocket costs when selecting this Medicare PPO plan.
Additional Benefits
The HumanaChoice H5216-389 (PPO) plan offers robust coverage for essential medical services, featuring no copay or coinsurance for primary care visits and a $25 copay for specialists. If you require hospital care, inpatient stays feature no coinsurance and a $415 daily copay for the first five days, followed by no copay for days six through 90. Emergency room visits carry a $130 copay, which is waived upon admission, while outpatient hospital services range from no copay up to an $800 copay. This plan also includes valuable preventive care with no copay, alongside routine hearing and dental exams that also feature no copay. Dental services are covered up to a $1,000 annual limit with a $25 copay for restorative work, and vision benefits include a $250 annual allowance for eyewear. For specialized needs, home health services require no copay, while durable medical equipment is covered with no copay and an 18% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-389 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $415 copay per day for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and while unlimited additional acute days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-389 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which have no copay. Outpatient hospital services carry a copay of $0 to $800, observation services require a $415 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-389 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-389 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance per service, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-389 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay 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, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Primary Care services are covered by HumanaChoice H5216-389 (PPO) with no copay and no coinsurance for primary care visits, while specialist visits require a $25 copay and no coinsurance. Other covered benefits like physical therapy, psychiatric care, and telehealth require copays ranging from $0 to $50 with no coinsurance, though chiropractic services are only partially covered with routine care excluded, and podiatry is not covered.
Preventive Services See details
HumanaChoice H5216-389 (PPO) provides preventive services with no copay and no coinsurance, covering annual physicals, kidney disease education, diabetes training, glaucoma screenings, EKGs, fitness benefits, and chemotherapy wigs. However, this benefit is only partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary services, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5216-389 (PPO) hearing services include routine exams and fitting evaluations with no copay, and Medicare-covered exams for a $25 copay, all with no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-389 (PPO) partially covers vision services with no coinsurance, offering eye exams with a $0 to $25 copay and eyewear with no copay up to a $250 annual limit. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-389 (PPO) dental services are partially covered up to a $1,000 annual maximum, though fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Preventive and adjunctive services require no copay and no coinsurance, while Medicare-covered dental and restorative services have a $25 copay and no coinsurance.
Home Infusion bundled Services See details
HumanaChoice H5216-389 (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance of no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-389 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-389 (PPO) covers durable medical equipment (DME) with an 18% coinsurance and no copay, and prosthetics and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-389 (PPO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $105, while therapeutic radiological services require a minimum $25 copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-389 (PPO) with no copay and no coinsurance. Prior authorization is required to access these services under the plan.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-389 (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. Patients will pay a $25 copay for cardiac and intensive cardiac rehabilitation services, and a $10 copay for pulmonary rehabilitation and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-389 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior 3-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered 100-day limit are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5216-389 (PPO), which excludes over-the-counter (OTC) items but covers acupuncture and meal benefits. Acupuncture is covered for up to 20 treatments per year with a $25 copay and no coinsurance, while chronic illness meal benefits are available with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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