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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 2025, 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 2025.
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 $151.00. 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 has a $300.00 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 $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) 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. For example, you may pay a $5 copay for preferred generic drugs at a standard pharmacy, but a 40% coinsurance for preferred brand drugs. In the initial coverage phase, you will pay these costs until your total drug costs reach $2,000. After this, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy; with this subsidy, you will pay $22.90.
Additional Benefits
The HumanaChoice H5216-449 (PPO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient and outpatient hospital services with copays, as well as emergency, primary care, and preventive services with no copays. Additionally, the plan covers hearing, vision, and dental services with copays or no copays, and offers coverage for ambulance, home health, and other services. The plan also includes specialized services, such as cardiac rehabilitation and skilled nursing facility, with copays and coinsurance applying to certain services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the HumanaChoice H5216-449 (PPO) plan, with a copay of $300 per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay between $0 and $300, and observation services with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services include individual and group sessions with a copay of $35.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-449 (PPO) plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground ambulance services with a $300 copay and air ambulance services with 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice H5216-449 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $25 copay; all have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $140 copay and no coinsurance.
Primary Care See details
The HumanaChoice H5216-449 (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, while occupational therapy services have a $10 copay. The plan also covers physician specialist services with a $25 copay. Mental health and psychiatric individual and group sessions have a $35 copay, and physical therapy and speech-language pathology services have a $10 copay. Additional telehealth benefits have a copay between $0 and $35, and opioid treatment program services have a $35 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services, including fitness benefits, kidney disease education, and other services, are covered, but some services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
The HumanaChoice H5216-449 (PPO) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $199 and $799, however prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$25, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5216-449 (PPO) plan provides dental services, including Medicare Dental Services with a $25 copay. Oral exams, dental X-rays, other diagnostic services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Restorative Services and Prosthodontics, removable are covered with no copay and 30-40% coinsurance, while Prosthodontics, fixed are covered with no copay and 30% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $3,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5216-449 (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices have a 20% coinsurance and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered with a copay for Medicare-covered procedures, tests, and lab services. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, while Therapeutic Radiological Services have a copay between $25 and $55, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-449 (PPO) plan with no copay and no coinsurance, but 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 the HumanaChoice H5216-449 (PPO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit, and copays apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5216-449 (PPO) plan, with a copay of $20 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice H5216-449 (PPO) plan covers acupuncture with a $25 copay and a limit of 20 treatments per year. The plan also covers a meal benefit with no copay. However, over-the-counter items, 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 are not covered.
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