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HumanaChoice H5216-390 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-390 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-390 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-390 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Delaware. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-390 (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 H5216-390 (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 H5216-390 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.70. 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 $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 HumanaChoice H5216-390 (PPO) Medicare prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, featuring a $5 copay for a 1-month supply and no copay for a 3-month supply when filled via preferred mail order. For brand-name and specialized medications, Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply. Tier 4 non-preferred drugs require a 50% coinsurance for both 1-month and 3-month supplies across all pharmacy options. Specialty medications in Tier 5 are subject to a 25% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H5216-390 (PPO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $20 copay, while inpatient hospital stays cost a $140 daily copay for the first 10 days followed by no copay for days 11 through 90. Emergency room visits have a $130 copay, which is waived if you are admitted, and urgent care services require a $50 copay. This plan also includes valuable supplemental benefits, such as dental coverage with a $2,500 annual limit and no copay for most preventive and comprehensive services. Routine vision and hearing exams are available with no copay, and the plan covers prescription hearing aids with copays ranging from $199 to $499. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, helping to keep essential health services highly accessible.
Inpatient Hospital See details
HumanaChoice H5216-390 (PPO) inpatient hospital services are partially covered with no coinsurance and a copay of $140 per day for days 1 to 10, followed by no copay for days 11 to 90. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
HumanaChoice H5216-390 (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $540 copay and observation services with a $140 copay per stay. Ambulatory surgical center and blood services are covered with no copay or coinsurance, while outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-390 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HumanaChoice H5216-390 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related locations is not covered.
Emergency Services See details
HumanaChoice H5216-390 (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 are covered with a $50 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-390 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Other covered services like physical therapy, mental health, and telehealth feature copays ranging from no copay up to $50 with no coinsurance, though routine chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-390 (PPO) preventive services are partially covered with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, diabetes training, and select screenings. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional tobacco cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
HumanaChoice H5216-390 (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $499 for up to two devices annually, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice H5216-390 (PPO) offers partially covered vision services with no coinsurance and no deductibles, featuring a $0 to $20 copay for eye exams and no copay for contact lenses or eyeglasses (lenses and frames). Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-390 (PPO) partially covers dental services with a $2,500 combined annual limit, offering most preventive and comprehensive care with no copay and no coinsurance. Medicare-covered dental services require a $20 copay and no coinsurance, while fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-390 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-390 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
HumanaChoice H5216-390 (PPO) covers durable medical equipment, prosthetic devices, 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 H5216-390 (PPO) covers diagnostic and radiological services, featuring no copay for lab services and outpatient X-rays, and no coinsurance with a $0 to $105 copay for diagnostic procedures. Diagnostic radiological services have a minimum $0 copay, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $20 copay, with prior authorization required.
Home Health Services See details
HumanaChoice H5216-390 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HumanaChoice H5216-390 (PPO) with no coinsurance and require prior authorization, but only some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered. For these services, you will pay a copayment ranging from $10.00 to $20.00.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-390 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5216-390 (PPO), with acupuncture requiring a $20 copay and no coinsurance for up to 20 treatments per year. Over-the-counter items and chronic illness meal benefits are covered with no copay and no coinsurance, while the sub-services Other 1, Other 2, and Other 3 are not covered.
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