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HumanaChoice H5216-437 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-437 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-437 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-437 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in CO, NM. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-437 (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice H5216-437 (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 H5216-437 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6200.00 (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 $6200.00 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
Prescription drugs are not covered by HumanaChoice H5216-437 (PPO).
Additional Benefits
The HumanaChoice H5216-437 (PPO) plan offers comprehensive medical coverage featuring no copays for primary care doctor visits, annual physicals, preventive screenings, and home health services. For more intensive medical needs, inpatient hospital stays require a $325 daily copay for the first six days, while emergency room visits carry a $115 copay that is waived upon admission. Outpatient surgical services and lab tests are also highly accessible, requiring no copays or coinsurance. This plan also includes strong supplemental benefits, such as up to $2,000 in dental coverage with no copays for preventive and comprehensive services. Members can take advantage of routine vision and hearing exams with no copays, alongside covered eyewear and up to 24 one-way transportation trips annually. Additional wellness perks like acupuncture, over-the-counter items, and chronic illness meals are also available with no copays or coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-437 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $325 daily copay for days 1 to 6, followed by no copay for days 7 to 90. Prior authorization is required, and while unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-437 (PPO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services have a $0 to $325 copay, observation services carry a $325 copay per stay, and substance abuse sessions require a $25 to $35 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice H5216-437 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under HumanaChoice H5216-437 (PPO), featuring a $335 copay for ground ambulance and a $630 copay for air ambulance with no coinsurance. Additionally, plan-approved transportation is covered with no copay or coinsurance for up to 24 one-way trips per year, though transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice H5216-437 (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $65 copay, with no coinsurance required for either service. Worldwide emergency, urgent, and emergency transportation services are also covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-437 (PPO) covers primary care and telehealth visits with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Therapy services carry a $35 copay and mental health services carry a $25 copay, both with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-437 (PPO) covers preventive services, including annual physicals, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive services are partially covered; smoking cessation and memory fitness have no copay and no coinsurance, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access technologies, safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered under HumanaChoice H5216-437 (PPO), featuring no copay and no coinsurance for routine hearing exams, fitting evaluations, and OTC hearing aids, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
HumanaChoice H5216-437 (PPO) partially covers vision services with no deductibles and no coinsurance, featuring a $0 to $40 copay for eye exams and no copay for covered eyewear. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered up to annual plan limits, other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-437 (PPO) partially covers dental services up to a $2,000 annual maximum, offering Medicare-covered dental services for a $40 copay and no coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance. While many diagnostic, restorative, and surgical procedures are included, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-437 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-437 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-437 (PPO) covers durable medical equipment and medical supplies with no copay and 15% coinsurance, while prosthetic devices have no copay and 20% coinsurance. Diabetic supplies are offered with no copay and 10% to 20% coinsurance, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-437 (PPO), with prior authorization required for these services. Lab and outpatient X-ray services feature no copay, diagnostic procedures require a $0 to $65 copay with no coinsurance, and therapeutic radiological services carry a minimum $30 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5216-437 (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 under the HumanaChoice H5216-437 (PPO) plan with no copay and no coinsurance, though prior authorization is required. In practice, some services are covered but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-437 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-437 (PPO) covers other services including acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits with no copays and no coinsurance. Prior authorization is required for the acupuncture and meal benefits, and acupuncture is limited to 25 treatments per year.
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