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HumanaChoice H5216-449 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-449 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-449 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-449 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Nashville. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-449 (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 H5216-449 (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 H5216-449 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $164.00. 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 $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
The HumanaChoice H5216-449 (PPO) prescription drug plan features an annual drug deductible of $615. You can save on medication costs with no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also budget-friendly, costing a $5 copay for a 1-month supply at standard pharmacies and no copay for a 3-month supply via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, though a 3-month preferred mail order reduces your cost to $131. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H5216-449 (PPO) plan offers affordable healthcare coverage with no copay for primary care physician visits and a $25 copay for specialists. Inpatient hospital stays require a $300 copay per admission, while outpatient hospital services feature copays ranging from no copay up to $300. Emergency department visits are covered with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Supplemental benefits include dental coverage up to a $3,000 annual limit with no copay for routine care, alongside routine vision and hearing exams that also feature no copay. Home health services and covered preventive care are fully covered with no copay, while diabetic supplies, durable medical equipment, and dialysis services require a 10% to 20% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-449 (PPO) covers inpatient acute and psychiatric hospital stays with a $300 copay per admission and no coinsurance, though prior authorization is required. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-449 (PPO) covers outpatient services with no copays or coinsurance for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $300, observation services carry a 20% coinsurance, and outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-449 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-449 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by HumanaChoice H5216-449 (PPO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services require a $150 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-449 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapies have a $10 copay, and mental health, psychiatric, and opioid treatment services carry a $35 copay, all with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-449 (PPO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and fitness benefits. However, several supplemental services are not covered, including health education, weight management programs, counseling, and home safety assessments.
Hearing Services See details
HumanaChoice H5216-449 (PPO) partially covers hearing services, offering Medicare-covered exams for a $25 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and copays ranging from $199 to $799, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-449 (PPO) partially covers vision services with no copay and no coinsurance for covered services, which include one routine eye exam and one pair of eyeglasses or contact lenses per year. Annual maximum benefits of $40 for exams and $350 for eyewear apply, though other eye exam services, separate lenses, separate frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-449 (PPO) partially covers dental services up to a $3,000 annual limit, with Medicare-covered dental requiring a $25 copay and no coinsurance. Other covered dental services feature no copay and either no coinsurance or a 30% to 40% coinsurance, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-449 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance of no coinsurance to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-449 (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 H5216-449 (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, 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, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
HumanaChoice H5216-449 (PPO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests carry a copay of $0 to $75 with no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $25 copay.
Home Health Services See details
HumanaChoice H5216-449 (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 by HumanaChoice H5216-449 (PPO) with no coinsurance and a $15 copay, requiring prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-449 (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 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by HumanaChoice H5216-449 (PPO) include acupuncture, which requires prior authorization and has a $25 copay and no coinsurance for up to 20 treatments per year. Chronic illness meal benefits are also covered with no copay and no coinsurance under prior authorization, while over-the-counter (OTC) items are not covered.
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