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HumanaChoice H5216-417 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-417 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-417 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-417 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in New Orleans Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-417 (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 H5216-417 (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 H5216-417 (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 $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 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 $6900.00 (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 $6900.00 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 H5216-417 (PPO) Medicare plan features an annual prescription drug deductible of $590. For Tier 1 preferred generic drugs, members pay no copay at standard pharmacies or through preferred mail order. Tier 2 generic medications cost as low as a $5 copay for a one-month supply, with no copay for a three-month supply when filled through preferred mail order. Tier 3 preferred brand-name drugs require a $47 copay for a one-month supply across standard pharmacies and mail-order options. For higher-tier medications, you will pay a coinsurance of 43% for Tier 4 non-preferred drugs and 26% for Tier 5 specialty drugs.
Additional Benefits
The HumanaChoice H5216-417 (PPO) plan offers affordable coverage for your everyday medical needs, featuring no copay for primary care doctor visits and a $45 copay for specialist appointments. If you require hospital care, inpatient stays have a $195 daily copay for the first seven days and no copay for days eight through 90. Emergency room visits require a $130 copay, which is waived if you are admitted, while urgently needed care carries a $50 copay. This plan also includes key supplemental benefits to help you save on dental, vision, and hearing services. You will enjoy preventive dental care with no copay or coinsurance up to a $2,000 annual limit, alongside routine eye and hearing exams with no copay. Additionally, the plan covers up to $250 annually for eyeglasses or contacts and provides coverage for prescription hearing aids with copays ranging from $599 to $899.
Inpatient Hospital See details
Inpatient hospital services are covered by HumanaChoice H5216-417 (PPO) with no coinsurance, requiring a $195 daily copay for days 1 through 7 and no copay for days 8 through 90 for both acute and psychiatric stays. This benefit is partially covered as unlimited additional acute days are covered with no copay, but additional psychiatric days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
HumanaChoice H5216-417 (PPO) covers outpatient services with no coinsurance, although prior authorization is required for most benefits. There is no copay for ambulatory surgical center or blood services, while outpatient hospital services require a copay of $0 to $275, observation services carry a $195 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-417 (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
HumanaChoice H5216-417 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
HumanaChoice H5216-417 (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 H5216-417 (PPO) primary care physician services feature no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapies have a $30 copay and no coinsurance, and mental health, psychiatric, and opioid treatment services carry a $35 copay and no coinsurance. Chiropractic and podiatry services are not covered, though telehealth benefits are available with a $0 to $50 copay and no coinsurance.
Preventive Services See details
HumanaChoice H5216-417 (PPO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, in-home support, and fitness programs. Uncovered services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered under HumanaChoice H5216-417 (PPO), featuring no coinsurance for all services, no copay for annual routine exams and fitting evaluations, and a $45 copay for Medicare-covered exams. Prescription hearing aids are partially covered with a $599 to $899 copay and no coinsurance for up to two aids per year, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-417 (PPO) with no deductible and no coinsurance, featuring eye exam copays ranging from $0 to $45. One routine eye exam (up to $75) and one pair of eyeglasses or contact lenses (up to a combined $250 limit) are covered annually with no copay, while other eye exams, individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-417 (PPO) offers partially covered dental services up to a $2,000 annual limit, featuring no copay and no coinsurance for preventive care and most comprehensive treatments. Medicare-covered dental services require a $45 copay and no coinsurance, prosthodontics require a 30% coinsurance and no copay, while fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-417 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-417 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice H5216-417 (PPO) covers medical equipment, featuring a 19% coinsurance and no copay for durable medical equipment (DME), and a 20% coinsurance with no copay for prosthetics and medical supplies. Diabetic supplies are covered with a 4% to 10% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-417 (PPO) with prior authorization, featuring no coinsurance and copays ranging from no copay to $75 for diagnostic tests and lab services. Outpatient X-rays and diagnostic radiology require no copay, while therapeutic radiological services require a $45 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-417 (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-417 (PPO) covers some cardiac rehabilitation services with a $15 copay and no coinsurance, subject to prior authorization. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-417 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay per day 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 100 days are not covered.
Other Services See details
HumanaChoice H5216-417 (PPO) provides coverage for select other services, including acupuncture with a $45 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan's other services benefit.
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