HumanaChoice H5216-428 (PPO)

HumanaChoice H5216-428 (PPO) is a PPO plan offered by Humana Insurance Company available for the 2026 plan year to people living in Select Counties in OR, UT, WA. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that HumanaChoice H5216-428 (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 H5216-428 (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.

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:

Drug Coverage

The HumanaChoice H5216-428 (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a 1-month supply and featuring no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs have a standard 1-month copay of $47 at both standard pharmacies and mail order services. For higher-tier prescriptions, cost-sharing transitions to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. This structured pricing helps beneficiaries understand exactly what they will pay for their medications under this HumanaChoice PPO plan.

Additional Benefits

The HumanaChoice H5216-428 (PPO) plan offers robust healthcare coverage with no copay or coinsurance for primary care visits, home health services, and preventive care. For inpatient hospital stays, members pay a copay for the first five days ($495 for acute and $458 for psychiatric care) and no copay for additional days, with no coinsurance required. Emergency room visits carry a $130 copay, which is waived if admitted within 24 hours, while urgent care visits require a $50 copay. This plan also includes valuable dental, vision, and hearing benefits, featuring no copay for preventive dental services up to a $1,500 annual limit and no copay for routine eye and hearing exams. Specialist visits and Medicare-covered dental services require a $45 copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, members can access over-the-counter items with no copay, though routine transportation services are not covered under this plan.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.