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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 robust medical coverage with no copay and no coinsurance for primary care visits and key preventive services. Specialist visits require a $40 copay, while emergency room care is covered with a $115 copay that is waived if you are admitted. For hospital stays, inpatient care carries a $325 daily copay for the first six days and no copay thereafter, while outpatient hospital services range from no copay up to a $325 copay with no coinsurance. This plan also includes valuable supplemental benefits, featuring dental coverage up to $2,000 with no copay on most preventive services and vision exams starting at no copay alongside a $200 annual eyewear allowance. Routine hearing exams and over-the-counter hearing aids require no copay, though prescription hearing aids carry a copay between $699 and $999. Additionally, durable medical equipment is covered with a 15% coinsurance and no copay, and home health services are fully covered with no copay or coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-437 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 and beyond. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-437 (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most care. There is no copay for ambulatory surgical center or blood services, while outpatient substance abuse sessions carry a $25 to $35 copay, and outpatient hospital or observation services require a copay of $0 to $325.
Partial Hospitalization See details
HumanaChoice H5216-437 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5216-437 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a $630 copay, with no coinsurance for either service. Although some transportation services are covered, transportation to plan-approved or any health-related locations 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, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-437 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Other covered services, including physical, occupational, and mental health therapies, require copays ranging from $25 to $40 with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-437 (PPO) covers key preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes training, with no copays and no coinsurance. Additional preventive benefits are only partially covered, as fitness benefits and smoking cessation counseling are included, while services like health education, weight management, in-home safety assessments, medical nutrition therapy, and counseling are not covered.
Hearing Services See details
HumanaChoice H5216-437 (PPO) covers Medicare-covered hearing exams for a $40 copay and no coinsurance, while routine annual exams and fitting evaluations have no copay or coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with no copay or coinsurance.
Vision Services See details
HumanaChoice H5216-437 (PPO) partially covers Vision Services with no deductible, offering eye exams with a $0 to $40 copay and no coinsurance, and contact lenses or eyeglasses with no copay and no coinsurance up to a $200 annual limit. Other eye exams, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
HumanaChoice H5216-437 (PPO) partially covers dental services up to a $2,000 annual limit, offering most preventive and comprehensive services with no copay and no coinsurance. However, Medicare-covered dental requires a $40 copay and no coinsurance, prosthodontics require no copay and a 30% coinsurance, and fluoride, implants, orthodontics, and maxillofacial prosthetics 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. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs carry a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5216-437 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-437 (PPO) covers durable medical equipment and medical supplies with a 15% coinsurance and no copay, and prosthetic devices with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-437 (PPO) covers diagnostic and radiological services with prior authorization, offering no coinsurance and no copay for lab services, and copays ranging from $0 to $65 for diagnostic procedures. Outpatient X-rays and diagnostic radiological services feature no copay, while therapeutic radiological services require a minimum $30 copay and at least 20% coinsurance.
Home Health Services See details
Home health services are covered under the HumanaChoice H5216-437 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the HumanaChoice H5216-437 (PPO) plan, which includes intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease. Since these services are not covered by the plan, there is no coverage, copay, or coinsurance available for them.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-437 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires no prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the standard 100 days.
Other Services See details
HumanaChoice H5216-437 (PPO) partially covers other services, offering acupuncture with a $10 copay and no coinsurance (up to 25 treatments per year with prior authorization) and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits and other miscellaneous services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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