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Humana Full Access H5216-412 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-412 (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 H5216-412 (PPO) in 2026, please refer to our full plan details page.
Humana Full Access H5216-412 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Illinois. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Full Access H5216-412 (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 H5216-412 (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 H5216-412 (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 $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $450.00 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 $4500.00 (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 $4500.00 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 H5216-412 (PPO) Medicare plan features a $400 drug deductible and offers competitive rates on generic medications. You will pay no copay for Tier 1 preferred generic drugs when using a standard pharmacy or preferred mail order. Tier 2 generic drugs cost as little as a $10 copay for a one-month supply, and you can completely avoid a copay by choosing a three-month supply through preferred mail order. For brand-name and specialty medications, costs are structured around fixed copays and coinsurance percentages. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, while Tier 4 non-preferred drugs carry a 50% coinsurance. Specialty medications in Tier 5 are covered with a 28% coinsurance, helping you plan your healthcare expenses under this Humana PPO plan.
Additional Benefits
The Humana Full Access H5216-412 (PPO) plan offers robust medical coverage featuring no copay for primary care physician visits and annual physical exams. Specialist visits require a $35 copay, while inpatient hospital stays carry a $425 daily copay for the first seven days and no copay for subsequent days. Emergency room visits require a $130 copay, which is waived if you are admitted to the hospital within 24 hours. For ancillary care, the plan provides dental coverage up to a $3,000 annual limit with no copay for most preventive and comprehensive services. Beneficiaries also benefit from routine vision and hearing exams with no copay, plus a $200 annual eyewear allowance. Home health services are covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Humana Full Access H5216-412 (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $425 daily copay for days 1 to 7 and no copay for days 8 and beyond. Inpatient psychiatric hospital stays are also covered with no coinsurance and a $325 daily copay for days 1 to 7, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Full Access H5216-412 (PPO) covers outpatient services with no coinsurance, although prior authorization is required for most services. Ambulatory surgical center and blood services have no copay, while outpatient hospital services require a $0 to $300 copay, observation services cost a $425 copay per stay, and outpatient substance abuse sessions carry a $20 to $35 copay.
Partial Hospitalization See details
Humana Full Access H5216-412 (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 H5216-412 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Humana Full Access H5216-412 (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 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Full Access H5216-412 (PPO) features primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Therapy services (physical, occupational, and speech) are covered with a $40 copay and no coinsurance, and mental health sessions carry a $20 copay and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the Humana Full Access H5216-412 (PPO) are covered with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit. However, additional preventive benefits are only partially covered, with services such as health education, weight management, in-home safety assessments, nutritional therapy, and alternative therapies not covered.
Hearing Services See details
Hearing services are covered by Humana Full Access H5216-412 (PPO) with no coinsurance, offering Medicare-covered exams for a $35 copay, and routine exams and fittings with no copay. Prescription hearing aids are partially covered with no coinsurance and a $699 to $999 copay (inner ear, outer ear, and over the ear models are not covered), while over-the-counter hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Full Access H5216-412 (PPO) offers partially covered vision services with no deductibles, featuring one routine eye exam per year with no copay and no coinsurance up to a $75 limit. Eyewear is also covered with no copay and no coinsurance up to a $200 annual maximum for one pair of contact lenses or eyeglasses (lenses and frames), though other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by Humana Full Access H5216-412 (PPO) up to a $3,000 annual limit, offering most preventive and comprehensive care with no copay and no coinsurance, while prosthodontics require a 30% coinsurance and no copay, and Medicare-covered dental has a $35 copay and no coinsurance. This partially covered benefit excludes fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana Full Access H5216-412 (PPO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Full Access H5216-412 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical equipment is covered by Humana Full Access H5216-412 (PPO), with durable medical equipment, medical supplies, and prosthetic devices requiring a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes and inserts carry a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Humana Full Access H5216-412 (PPO) plan, requiring prior authorization. Diagnostic services have no coinsurance, offering lab services with no copay and diagnostic procedures with a copay of $0 to $95. Radiological services feature no copay for outpatient X-rays, a minimum $0 copay for diagnostic radiology, and a copay alongside a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Humana Full Access H5216-412 (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 covered by Humana Full Access H5216-412 (PPO) with no coinsurance and prior authorization required, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, requiring copays between $20 and $35.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Full Access H5216-412 (PPO) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required before admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Full Access H5216-412 (PPO) partially covers other services, as Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered. Covered benefits include acupuncture with a $35 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance.
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