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HumanaChoice H5216-448 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-448 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-448 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-448 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in North Alabama. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-448 (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 H5216-448 (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 H5216-448 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $124.00. 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.
This plan has a $615.00 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 $6000.00 (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 $6000.00 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 H5216-448 (PPO) Medicare plan features an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible and a Part D premium of $51.90. After meeting the deductible, Tier 1 preferred generic drugs require a $5.00 copay at standard pharmacies and preferred mail, or a $20.00 copay via standard mail. Tier 2 standard generics cost a $47.00 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs require 48% and 25% coinsurance respectively. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase. During this phase, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice H5216-448 (PPO) plan offers strong medical coverage featuring no copay for primary care visits and a $25 copay for specialist visits. If you require hospital care, inpatient stays carry a $300 copay per stay, while emergency room visits require a $150 copay which is waived if you are admitted. Outpatient hospital services range from no copay to a $300 copay, and core preventive services are fully covered with no copay or coinsurance. For extra health benefits, this plan provides routine hearing and vision exams with no copay, alongside dental benefits that cover preventive care with no copay up to a $3,000 annual limit. Additionally, home health services feature no copay, and skilled nursing facility stays require no copay for days 1 through 20 followed by a $218 copay for days 21 through 100. Diagnostic lab services and outpatient X-rays are also available with no copay.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by HumanaChoice H5216-448 (PPO) with a $300 copay per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-448 (PPO) covers outpatient services, featuring a $0 to $300 copay for outpatient hospital services and a 20% coinsurance for observation services. Patients will pay no copay for ambulatory surgical center and outpatient blood services, while individual and group outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-448 (PPO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required to access this covered service.
Ambulance and Transportation Services See details
HumanaChoice H5216-448 (PPO) partially covers Ambulance and Transportation Services, though transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $335 copay and no coinsurance, while air ambulance services require 20% coinsurance and no copay.
Emergency Services See details
HumanaChoice H5216-448 (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-448 (PPO) partially covers Primary Care benefits, as routine chiropractic care and podiatry services are not covered. Covered services require no coinsurance, featuring no copay for primary care visits, a $25 copay for specialists, and other therapy, psychiatric, and mental health copays ranging from $10 to $35.
Preventive Services See details
HumanaChoice H5216-448 (PPO) covers core preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered, excluding services like health education, weight management, nutritional therapy, and home safety assessments.
Hearing Services See details
HumanaChoice H5216-448 (PPO) offers hearing services with no copay or coinsurance for annual routine exams and fitting evaluations, while Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $199 to $799 and no coinsurance for up to two devices per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5216-448 (PPO) with no deductible and no coinsurance, featuring routine eye exams with no copay and other eye exams with a $0 to $25 copay. Eyewear is covered with no copay up to a $350 annual limit, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-448 (PPO) partially covers dental services up to a $3,000 annual maximum, offering no copay for most preventive and diagnostic care but requiring a $25 copay for Medicare dental services and a 30% to 40% coinsurance for restorative and prosthodontic services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-448 (PPO) covers Home Infusion bundled Services, requiring prior authorization and step therapy. Medicare Part B insulin drugs have a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy and other Part B drugs feature no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice H5216-448 (PPO) plan with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment benefits are covered by HumanaChoice H5216-448 (PPO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies require a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts carry a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H5216-448 (PPO) covers diagnostic and radiological services, with prior authorization required. Lab services have no copay or coinsurance, diagnostic tests range from a $0 to $65 copay with no coinsurance, diagnostic radiology has a $0 to $335 copay with no coinsurance, therapeutic radiology requires a $25 copay and 20% coinsurance, and outpatient X-rays feature no copay.
Home Health Services See details
HumanaChoice H5216-448 (PPO) covers home health services 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 H5216-448 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all excluded from coverage. Since these services are not covered, there are no associated copays or coinsurance.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-448 (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and offering no copay or coinsurance for days 1 through 20, followed by a $218 copay and no coinsurance for days 21 through 100. Additional days beyond those covered by Medicare are not covered under this plan.
Other Services See details
Other Services are partially covered by HumanaChoice H5216-448 (PPO), which excludes over-the-counter (OTC) items and dual eligible SNPs. Covered benefits require prior authorization and include acupuncture for a $25 copay and no coinsurance (up to 20 treatments per year), and meal benefits for chronic illnesses with no copay and no coinsurance.
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