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HumanaChoice H5216-434 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-434 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-434 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-434 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Denver. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-434 (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 H5216-434 (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 H5216-434 (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 $11.00. 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 $200.00 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 $8950.00 (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 $8950.00 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 H5216-434 (PPO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you'll pay a $10 copay for preferred generic drugs at a standard pharmacy, and 43% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-434 (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay of $380 for days 1-5, and no copay for days 6-90. Primary care visits have a $5 copay, and specialist visits have a $45 copay. Preventive services, such as an annual physical exam, and many outpatient services have no copay. This plan covers emergency services with a $125 copay and outpatient services with varying copays. Hearing exams have a $45 copay, and routine eye exams have a $0-$45 copay. Dental services have a $45 copay, and a maximum of $2,500 for other dental services. The plan also includes home health services with no copay, and skilled nursing facility services with a $10-$214 copay depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a copay of $380 for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $415, Observation Services have a $380 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay between $45 and $65, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-434 (PPO) plan, with a $100 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice H5216-434 (PPO). Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $630 copay, and both have no coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the HumanaChoice H5216-434 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $55 copay; all have no coinsurance.
Primary Care See details
The HumanaChoice H5216-434 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay and occupational therapy services with a $45 copay. The plan also covers physician specialist services with a $45 copay, mental health specialty services with a $45 copay, podiatry services with a $45 copay, and physical therapy and speech-language pathology services with a $45 copay. Additionally, the plan offers telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a copay between $45 and $65.
Preventive Services See details
The HumanaChoice H5216-434 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered. Prescription hearing aids have a copay between $399 and $699, depending on the type.
Vision Services See details
The HumanaChoice H5216-434 (PPO) plan covers vision services, including routine eye exams with a copay of $0-$45 and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-434 (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services with a $2,500 maximum. 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. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice H5216-434 (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with an 18% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The HumanaChoice H5216-434 (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $100 and lab services with no copay. Diagnostic radiological services have a copay up to $415, while therapeutic radiological services have a copay up to $40 and coinsurance up to 20%. Outpatient X-ray services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-434 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice H5216-434 (PPO) plan, but none of the sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5216-434 (PPO) plan. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay; this plan does not cover additional days beyond Medicare-covered, or non-Medicare-covered stays.
Other Services See details
Under "Other Services," HumanaChoice H5216-434 (PPO) covers acupuncture with a $45 copay, and a meal benefit with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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