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HumanaChoice H5216-450 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-450 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-450 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-450 (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 H5216-450 (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 H5216-450 (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 H5216-450 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $210.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $400.00 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 $10000.00 (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 $10000.00 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 H5216-450 (PPO) prescription drug plan features an annual drug deductible of $400. For Tier 1 preferred generic drugs, members pay no copay for 1-month or 3-month supplies filled at standard pharmacies or through preferred mail order. Tier 2 generic medications cost a $5 copay for a 1-month supply at standard pharmacies, but members can receive a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs cost a $47 copay for a 1-month supply, though you can save on a 3-month supply using preferred mail order for a $131 copay. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 48% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply across all pharmacy and mail order options.
Additional Benefits
The HumanaChoice H5216-450 (PPO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs. You will pay no copay for primary care visits, while specialist visits require a $30 copay and inpatient hospital stays carry a $295 daily copay for the first several days. Emergency room visits have a $130 copay, which is waived if you are admitted, and outpatient hospital services range from no copay up to a $350 copay. This plan also features strong supplemental benefits, including routine vision and hearing exams with no copay, alongside dental coverage up to a $2,000 annual limit. Home health services and the first 20 days of skilled nursing facility stays require no copay, while durable medical equipment carries a 20% coinsurance. Diagnostic lab work and outpatient X-rays are also available with no copay, helping you manage your health affordably.
Inpatient Hospital See details
HumanaChoice H5216-450 (PPO) inpatient hospital benefits are partially covered with no coinsurance, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Covered acute stays require a $295 daily copay for days 1 to 6 (no copay for days 7 and beyond), while psychiatric stays require a $295 daily copay for days 1 to 5 (no copay for days 6 to 90).
Outpatient Services See details
HumanaChoice H5216-450 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5216-450 (PPO) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HumanaChoice H5216-450 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, with prior authorization required for all ambulance services. Transportation services, including trips to plan-approved or other health-related locations, are not covered.
Emergency Services See details
HumanaChoice H5216-450 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-450 (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapy require a $23 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by HumanaChoice H5216-450 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management. While fitness and in-home support are included, several supplemental benefits are not covered, including health education, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are partially covered by the HumanaChoice H5216-450 (PPO) plan, offering Medicare-covered exams for a $30 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $399 to $699 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-450 (PPO) partially covers vision services, providing routine eye exams and select eyewear with no copay, no coinsurance, and no deductible. Annual maximum coverage limits apply, and certain services such as other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-450 (PPO) dental services are partially covered up to a $2,000 annual maximum, with Medicare-covered dental requiring a $30 copay and no coinsurance. Most covered preventive and comprehensive services feature no copay and coinsurance ranging from no coinsurance up to 40%, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-450 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance of 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
HumanaChoice H5216-450 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
HumanaChoice H5216-450 (PPO) covers medical equipment, including durable medical equipment and prosthetics with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5216-450 (PPO) covers diagnostic and radiological services with prior authorization, featuring no copay for lab work and outpatient X-rays. Diagnostic procedures have no coinsurance and copays ranging from $0 to $75, while therapeutic radiological services require a minimum 20% coinsurance and a $30 copay.
Home Health Services See details
Home health services are covered under the HumanaChoice H5216-450 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-450 (PPO) offers Cardiac Rehabilitation Services with no coinsurance and prior authorization, meaning some services are covered. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by HumanaChoice H5216-450 (PPO) with no coinsurance and do not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare limit are not covered.
Other Services See details
HumanaChoice H5216-450 (PPO) partially covers other services, featuring acupuncture with a $30 copay and no coinsurance for up to 20 treatments annually, alongside chronic illness meal benefits with no copay or coinsurance. Both services require prior authorization, while over-the-counter (OTC) items are not covered.
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