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Humana Full Access H5216-432 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5216-432 (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 H5216-432 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access H5216-432 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Austin area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Full Access H5216-432 (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 H5216-432 (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 H5216-432 (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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $345.00 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 $11700.00 (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 $11700.00 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 H5216-432 (PPO) plan has a $345 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay a $9 copay at preferred pharmacies or via mail order, and a $20 copay at standard pharmacies. For standard generic drugs, you will pay a $47 copay regardless of the pharmacy. Brand-name drugs have a coinsurance of 42% at all pharmacies, while non-preferred drugs have a 28% coinsurance.
Additional Benefits
The Humana Full Access H5216-432 (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. It also includes coverage for primary care, preventive services, hearing, vision, and dental services. You'll find additional benefits like ambulance services, emergency care, and coverage for home health and skilled nursing facilities, with some services requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $350 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $335 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Humana Full Access H5216-432 (PPO) plan includes coverage for Outpatient Hospital Services with a copay between $0 and $325, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay between $30 and $100, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Full Access H5216-432 (PPO) plan, but requires prior authorization. You will have a $35 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Full Access H5216-432 (PPO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Full Access H5216-432 (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay, and Worldwide Emergency Services has a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $15 copay. Occupational Therapy Services have a $25 copay, and Physician Specialist Services have a $40 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a $30 copay, and Physical Therapy and Speech-Language Pathology Services have a $25 copay. Additional Telehealth benefits have a copay between $0 and $45, and Opioid Treatment Program Services have a copay between $30 and $100. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional preventive services with no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Other services like health education, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams have no copay. Fitting/evaluation for hearing aids have no copay, while prescription hearing aids (all types) have a copay between $199 and $499. OTC hearing aids are covered up to a maximum of $50 every three months.
Vision Services See details
The Humana Full Access H5216-432 (PPO) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $3,000 maximum plan benefit annually. Medicare Dental Services have a $40 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Humana Full Access H5216-432 (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%. For all other drugs, coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Full Access H5216-432 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Humana Full Access H5216-432 (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The Humana Full Access H5216-432 (PPO) plan covers Diagnostic and Radiological Services. Diagnostic Procedures/Tests have a copay between $0 and $175, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, while Therapeutic Radiological Services have a copay up to $40 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5216-432 (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Full Access H5216-432 (PPO) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Full Access H5216-432 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Under the "Other Services" benefit, acupuncture has a $40 copay, and the plan covers up to 20 treatments per year. The plan also covers over-the-counter (OTC) items, including nicotine replacement therapy and Naloxone, up to $50 every three months, and unused amounts carry over. Meal benefits are covered with no copay, and prior authorization is required. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and many other services are not covered.
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