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HumanaChoice H5216-397 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-397 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-397 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-397 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Minnesota and Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-397 (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 H5216-397 (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 H5216-397 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $56.00. 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 $700.00 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 $6200.00 (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 $6200.00 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 H5216-397 (PPO) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, for a preferred generic drug, you will pay a $10 copay at a standard or mail order pharmacy. For standard generic drugs, the copay is $47, and for preferred brand drugs you pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-397 (PPO) plan offers a range of benefits, including inpatient hospital stays with a $400 copay for the first 4 days, and outpatient services with varying copays. The plan includes coverage for primary care with no copay, and covers hearing, vision, and dental services with specific copays and maximum benefits. Additional benefits include ambulance services with a $315 copay for ground transport, emergency services with a $140 copay, and home health services with no copay. The plan also covers preventive services like annual physical exams with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 4 days, the copay is $400 per admission, with no copay for days 5-90; additional days for Inpatient Hospital-Acute have no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by HumanaChoice H5216-397 (PPO). Outpatient hospital services have a copay between $0 and $300, observation services have a $400 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse services have a copay between $35 and $85 for individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-397 (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The HumanaChoice H5216-397 (PPO) plan covers ambulance services with a $315 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice H5216-397 (PPO) plan. Emergency Services has a $140 copay with no coinsurance, while Urgently Needed Services has a $65 copay with no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each have a $140 copay with no coinsurance.
Primary Care See details
The HumanaChoice H5216-397 (PPO) plan covers Primary Care Physician Services with no copay and covers Chiropractic Services with a $20 copay, but routine care is not covered. Occupational therapy services have a $40 copay, while Physician Specialist Services have a $35 copay. Individual and group sessions for both mental health and psychiatric services have a $35 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a copay between $0 and $65. Opioid Treatment Program Services have a copay between $35 and $85.
Preventive Services See details
The HumanaChoice H5216-397 (PPO) plan covers preventive services, including an annual physical exam with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Other preventive services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and eyewear with no copay, with a combined maximum benefit of $100 per year. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $2,500 maximum benefit per year. Medicare Dental Services have a $35 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services have no copay. Restorative Services and Prosthodontics, removable have no copay, but a 30-40% and 30% coinsurance respectively. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-397 (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance with no copay, and Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $85, and lab services with no copay. Therapeutic Radiological Services have a 20% coinsurance, while Diagnostic Radiological Services have a maximum copay of $400, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-397 (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 listed sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A copay may be required, but the specific amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-397 (PPO) plan, but require prior authorization. The plan has a copay of $20 for days 1-20 and $203 for days 21-100, but does not cover additional days beyond Medicare-covered, or non-Medicare-covered stays for SNF.
Other Services See details
The HumanaChoice H5216-397 (PPO) plan covers acupuncture with a $35 copay, and a meal benefit with no copay. Other services like over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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