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HumanaChoice H5216-399 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-399 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-399 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-399 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in IL. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-399 (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 H5216-399 (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 H5216-399 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. 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 $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 $10100.00 (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 $10100.00 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 H5216-399 (PPO) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a one-month supply or no copay for a three-month supply using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, while a three-month supply is $131 through preferred mail order and $141 through standard pharmacy or standard mail order options. For higher-tier medications, Tier 4 non-preferred drugs carry a 37% coinsurance and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply.
Additional Benefits
The HumanaChoice H5216-399 (PPO) plan offers affordable medical coverage with no copay for primary care physician visits and a $50 copay for specialists, with no coinsurance for either. Inpatient hospital stays require a $425 daily copay for the first seven days followed by no copay, while emergency room visits have a $130 copay that is waived upon admission. Outpatient hospital services and surgeries feature no coinsurance and range from no copay to a $300 copay. For supplemental care, the plan provides routine dental, vision, and hearing exams with no copay and no coinsurance, alongside a $2,000 annual maximum for dental services. Home health services and diagnostic lab tests are also covered with no copay, while durable medical equipment and dialysis require a 20% coinsurance. Additionally, acupuncture is covered with a $50 copay, while over-the-counter items and routine transportation services are not covered by the plan.
Inpatient Hospital See details
HumanaChoice H5216-399 (PPO) covers inpatient hospital services with no coinsurance, though it is only partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute inpatient stays require a $425 copay for days 1 through 7 and no copay for days 8 and beyond, while psychiatric stays require a $320 copay for days 1 through 7 and no copay for days 8 through 90.
Outpatient Services See details
Outpatient services covered by HumanaChoice H5216-399 (PPO) feature no coinsurance, with no copays for ambulatory surgical center services and outpatient blood services, which also has no deductible. Outpatient hospital services require a $0 to $300 copay, observation services have a $425 copay per stay, and substance abuse sessions carry a $30 to $35 copay, all with no coinsurance.
Partial Hospitalization See details
HumanaChoice H5216-399 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
HumanaChoice H5216-399 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice H5216-399 (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 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
HumanaChoice H5216-399 (PPO) provides primary care physician services with no copay and no coinsurance, and physician specialist visits with a $50 copay and no coinsurance. Most other covered care benefits, including therapy, mental health, and telehealth services, range from no copay to a $50 copay with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-399 (PPO) partially covers preventive services with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and diabetes self-management. However, additional preventive services such as fitness benefits, health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
HumanaChoice H5216-399 (PPO) hearing services include routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $50 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two aids per year, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-399 (PPO) offers partially covered vision services with no deductibles and no coinsurance, requiring a $0 to $50 copay for eye exams and no copay for eyewear. Routine eye exams and eyeglasses or contact lenses are covered up to annual benefit limits, but other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-399 (PPO) features partially covered dental services with a $2,000 annual maximum for combined in-network and out-of-network care. Most covered preventive and comprehensive services require no copay and no coinsurance, while Medicare-covered dental has a $50 copay (no coinsurance), prosthodontics require a 30% coinsurance (no copay), and fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-399 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-399 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-399 (PPO) covers durable medical equipment, 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 and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-399 (PPO), with prior authorization required. Lab services feature no copay and no coinsurance, diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $95, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-399 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Some Cardiac Rehabilitation Services are covered under HumanaChoice H5216-399 (PPO) with no coinsurance and required prior authorization, but several sub-services are not covered in practice. Specifically, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered, with associated copays ranging from $15 to $40.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5216-399 (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-399 (PPO) provides partial coverage for other services, featuring acupuncture with a $50 copay and no coinsurance for up to 20 treatments per year, alongside a chronic illness meal benefit with no copay and no coinsurance. Prior authorization is required for these covered services, and over-the-counter (OTC) items are not covered.
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