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HumanaChoice H5216-440 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-440 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-440 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-440 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Tucson. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5216-440 (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 H5216-440 (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 H5216-440 (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:
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Drug Coverage
The HumanaChoice H5216-440 (PPO) plan has a $300 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a standard pharmacy and 41% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-440 (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay of $350 for the first five days and no copay for days 6-90. It also covers outpatient services, primary care, and specialist visits with varying copays. This plan includes coverage for emergency services, hearing exams, vision services, and dental services. Additionally, the plan covers home health services with no copay, as well as medical equipment and diagnostic services with coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered with a $350 copay 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 for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0 - $350, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay of $45 - $65 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5216-440 (PPO) plan, with a $100 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The HumanaChoice H5216-440 (PPO) plan 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 Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay.
Primary Care See details
The HumanaChoice H5216-440 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $45 copay, and physical therapy and speech-language pathology services with a $45 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $45 copay, while additional telehealth benefits have a copay ranging from $0 to $45, and podiatry services have a $45 copay for covered services. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, as well as no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Other preventive services, including 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 (including Web/Phone-based technologies and Nursing Hotline), 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 have no copay. Fitting/evaluation for hearing aids has no copay, and prescription hearing aids have a copay of $599. OTC hearing aids are covered up to a maximum of $75 every three months.
Vision Services See details
Vision Services include coverage for eye exams, with a copay between $0 and $45, and eyewear, with no copay. Routine eye exams have no copay, while contact lenses and eyeglasses (lenses and frames) have no copay; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $2,000 per year for both in-network and out-of-network services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery have no copay. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-440 (PPO) plan and require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The HumanaChoice H5216-440 (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $125, Lab Services have no copay, and Outpatient X-Ray Services have a $5 copay. Diagnostic Radiological Services have a copay up to $350, and Therapeutic Radiological Services have a copay up to $50 and coinsurance up to 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-440 (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, but no specific sub-services are covered. Prior authorization is required, and the plan does not specify any cost sharing.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5216-440 (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 stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $45 copay, over-the-counter items, and a meal benefit with no copay. This plan does not cover 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.
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