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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 2025, 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 2025.
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 $24.90. 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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, you may pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy. For preferred brand drugs, you'll pay 50% coinsurance, and for non-preferred drugs, you'll pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you'll pay nothing for covered Part D drugs, though you may still pay for excluded drugs under any enhanced benefit.
Additional Benefits
The HumanaChoice H5216-390 (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. Emergency, urgent, and worldwide emergency services are covered, with copays ranging from $55 to $125, and no coinsurance. Preventive services and many vision and dental services have no copay. This plan also covers hearing exams, prescription hearing aids, and medical equipment with copays or coinsurance. Other notable benefits include no copay for home health services, and a $20 copay for acupuncture. The plan also includes an over-the-counter allowance of $50 per month, and meal benefits.
Inpatient Hospital See details
Inpatient Hospital coverage includes both acute and psychiatric services, with a $140 copay for days 1-10, and no copay for days 11-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $540, Observation Services with a $140 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $30 and $80 for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-390 (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $315 copay. Transportation Services to plan-approved health-related locations are covered with no copay, with a limit of 76 one-way trips per year. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice H5216-390 (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $55 copay, and both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay, with no coinsurance.
Primary Care See details
For the HumanaChoice H5216-390 (PPO) plan, primary care physician services have no copay, chiropractic services have a $15 copay, and occupational therapy services have a copay between $20 and $30. Physician specialist services have a $20 copay, and mental health specialty services, psychiatric services, and opioid treatment program services have copays between $30 and $80. Physical therapy and speech-language pathology services have a copay between $20 and $30, and additional telehealth benefits have a copay between $0 and $55. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services and additional services, such as an annual physical exam, with no copay. The plan also covers wigs for hair loss related to chemotherapy, with no copay and a maximum plan benefit coverage amount of $500 per year. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay. Routine hearing exams, fitting/evaluation for hearing aids, and OTC hearing aids are covered with no copay. Prescription hearing aids are partially covered, with only "Prescription Hearing Aids (all types)" being covered with a copay between $299 and $599, while the others are not covered.
Vision Services See details
The HumanaChoice H5216-390 (PPO) plan covers vision services including eye exams with a copay between $0 and $20, and eyewear with no copay, but does not cover eyeglass lenses, eyeglass frames, or upgrades. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay.
Dental Services See details
The HumanaChoice H5216-390 (PPO) plan's dental services include a $20 copay for Medicare Dental Services, no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit coverage of $2500 per year for both in and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, depending on the specific drug. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%, depending on the specific drug.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-390 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The HumanaChoice H5216-390 (PPO) plan covers medical equipment including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices have a 20% coinsurance. Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10% coinsurance with no copay. Diabetic Therapeutic Shoes/Inserts have a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services, and the maximum copay is $105.00. Lab services have no copay. Radiological services include coverage for diagnostic and therapeutic radiological services, with a maximum copay of $325 and $20, respectively, and a coinsurance of at most 20% for therapeutic radiological services. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-390 (PPO) 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 not covered by the HumanaChoice H5216-390 (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-390 (PPO), with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice H5216-390 (PPO) plan covers acupuncture with a $20 copay, and up to 20 treatments per year. Over-the-counter (OTC) items are covered with a maximum benefit of $50 per month, and unused amounts carry forward. Meal benefits are covered with no copay.
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