A non-government entity
HumanaChoice H5216-439 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-439 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-439 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-439 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Phoenix. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-439 (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 H5216-439 (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 H5216-439 (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 $10.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $300.00 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 $10100.00 (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 $10100.00 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:
Sign up for HumanaChoice H5216-439 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5216-439 (PPO) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies and a $20 copay at standard mail pharmacies. For preferred brand drugs and non-preferred drugs, you pay coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5216-439 (PPO) plan offers a range of benefits including inpatient and outpatient hospital services with varying copays. You'll find no copay for primary care visits and many preventive services, but other services like specialist visits and ambulance services have set copays. This plan covers hearing and vision services, including hearing exams with a $45 copay, and eye exams with no copay. Dental services are included with a $45 copay for Medicare-covered services, and other dental services have no copay up to a $2000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric services, are covered under the HumanaChoice H5216-439 (PPO) plan. For Acute services, you will pay a $350 copay for days 1-5, and no copay for days 6-90; Additional days have no copay. Psychiatric services have the same cost-sharing as Acute services.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by HumanaChoice H5216-439 (PPO). Outpatient Hospital Services have a copay between $0 and $350, while Observation Services have a $350 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay between $45 and $60.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-439 (PPO) plan, but requires prior authorization. The copay for this benefit is $100.
Ambulance and Transportation Services See details
HumanaChoice H5216-439 (PPO) covers ambulance services with a $315 copay for ground ambulance services and a $630 copay for air ambulance services, but transportation services to health-related locations are not covered. There is no coinsurance for ambulance services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay, while all services have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-439 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, and physician specialist services with a $45 copay. The plan also covers mental health, podiatry, other health care professional, psychiatric, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services with varying copays. Routine chiropractic care is not covered.
Preventive Services See details
The HumanaChoice H5216-439 (PPO) plan covers a variety of preventive services. Annual physical exams have no copay. Other preventive services include Fitness Benefit (Memory Fitness), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams are covered with no copay for one visit every year. Fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with a maximum copay of $599 every three years. OTC hearing aids are covered with a maximum benefit of $75.00 every three months.
Vision Services See details
Vision services include eye exams with a copay of $0-$45, and eyewear with no copay, including contact lenses and eyeglasses (lenses and frames); however, eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams are covered with no copay, and one pair of contact lenses or eyeglasses (lenses and frames) are covered per year.
Dental Services See details
The HumanaChoice H5216-439 (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services including 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, all with no copay, but with limitations on the number of visits and periodicity. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered. The plan offers a maximum benefit of $2000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice H5216-439 (PPO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-439 (PPO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, Medical Supplies, and Diabetic Equipment, is covered under the HumanaChoice H5216-439 (PPO) plan. Durable Medical Equipment has an 18% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $125, lab services with no copay, diagnostic radiological services with a copay up to $350, therapeutic radiological services with a copay up to $50 and 20% coinsurance, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-439 (PPO) plan with no copay and no coinsurance, however, additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-439 (PPO), but the plan does not cover any Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-439 (PPO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The HumanaChoice H5216-439 (PPO) plan covers acupuncture with a $45 copay, and also offers over-the-counter (OTC) items with a $75 maximum benefit every three months. The plan provides a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved