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Humana Full Access H5216-411 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-411 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5216-411 (PPO) in 2026, please refer to our full plan details page.
Humana Full Access H5216-411 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Iowa and Nebraska. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Full Access H5216-411 (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 Humana Full Access H5216-411 (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 Humana Full Access H5216-411 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $325.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $400.00 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 Humana Full Access H5216-411 (PPO) plan features an annual prescription drug deductible of $400. For Tier 1 preferred generic drugs, members pay no copay when using standard pharmacies or preferred mail order services. Tier 2 generic medications cost a $5 copay for a 1-month supply at standard pharmacies, but you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, though a 3-month supply via preferred mail order lowers the cost to $131. For higher-tier prescriptions, members pay a 47% coinsurance for Tier 4 non-preferred drugs and a 28% coinsurance for Tier 5 specialty medications.
Additional Benefits
The Humana Full Access H5216-411 (PPO) plan provides comprehensive medical coverage with no copay and no coinsurance for primary care visits, routine preventive services, and home health care. Specialist visits, physical therapy, and occupational therapy require a $40 copay with no coinsurance. For hospital stays, there is a daily copay of $395 for the first seven days of acute inpatient care and up to a $300 copay for outpatient hospital services, both with no coinsurance. This plan also includes valuable supplemental benefits, featuring routine dental care up to a $2,500 annual limit and routine vision exams with no copay or coinsurance. Routine hearing exams and over-the-counter hearing aids are also covered with no copay, while prescription hearing aids require copays between $699 and $999. Additionally, diagnostic labs and outpatient X-rays are available with no copay, while durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
Humana Full Access H5216-411 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a copay of $395 per day for days 1-7 of acute stays and $310 per day for days 1-7 of psychiatric stays, with no copay for subsequent covered days. Non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Full Access H5216-411 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 to $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Full Access H5216-411 (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
Humana Full Access H5216-411 (PPO) covers ambulance services with a $335 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required. While some transportation services are covered, trips to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Humana Full Access H5216-411 (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, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
Humana Full Access H5216-411 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $40 copay and no coinsurance. Mental health, psychiatric, and telehealth services are covered with no coinsurance and copays ranging from $0 to $50, though chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Full Access H5216-411 (PPO) provides preventive services with no copay and no coinsurance, covering annual physical exams, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, EKGs, and a memory fitness benefit. This benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
Humana Full Access H5216-411 (PPO) covers hearing services with no deductible, offering Medicare-covered exams for a $40 copay and routine exams with no copay, both with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $699 and $999, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Humana Full Access H5216-411 (PPO) with no copay and no coinsurance for routine eye exams and select eyewear, subject to prior authorization. This plan covers one routine exam (up to $75 annually) and contact lenses or eyeglasses (up to a $100 annual limit), but other eye exams, separate lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Full Access H5216-411 (PPO) offers partially covered dental services up to a $2,500 annual limit, with a $40 copay and no coinsurance for Medicare-covered dental care. Most other covered services have no copay and no coinsurance, though removable and fixed prosthodontics require a 30% coinsurance and no copay, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Full Access H5216-411 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Full Access H5216-411 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered by Humana Full Access H5216-411 (PPO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Full Access H5216-411 (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures range from a $0 to $95 copay, and therapeutic radiology requires a minimum copay of $40.
Home Health Services See details
Home health services are covered under the Humana Full Access H5216-411 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice by the Humana Full Access H5216-411 (PPO) plan, as all sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Humana Full Access H5216-411 (PPO) covers Skilled Nursing Facility (SNF) services 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 while a prior three-day hospital stay is not needed, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Humana Full Access H5216-411 (PPO) plan, featuring acupuncture for a $40 copay and no coinsurance, up to 20 treatments per year with prior authorization. Over-the-counter (OTC) items and chronic illness meal benefits are also included with no copay and no coinsurance, while other unspecified services (Other 1, 2, and 3) are not covered.
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