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Humana Value Choice H5216-451 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Choice H5216-451 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Choice H5216-451 (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Humana Value Choice H5216-451 (PPO) is a PPO plan offered by Humana Insurance Company available for the 2026 plan year 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 Humana Value Choice H5216-451 (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 Humana Value Choice H5216-451 (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 Humana Value Choice H5216-451 (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 $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $800.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4201.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4201.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $5700.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5700.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Humana Value Choice H5216-451 (PPO) plan features an annual drug deductible of $590. Tier 1 preferred generic drugs have no copay when filled at a standard pharmacy or through preferred mail order. Tier 2 generic drugs cost $5 for a one-month supply at standard pharmacies and preferred mail order, with no copay for a three-month supply through preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply. Tier 4 non-preferred drugs require a 40% coinsurance, and Tier 5 specialty drugs have a 26% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Humana Value Choice H5216-451 (PPO) plan offers affordable coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $50 copay, while inpatient hospital stays incur a $332 daily copay for days one through nine with no coinsurance. Outpatient hospital care has a copay ranging from $0 to $250, and emergency room visits are covered with a $115 copay. For extra benefits, the plan provides routine vision exams and dental care with no copay and no coinsurance, up to a $1,250 annual dental maximum. Prescription hearing aids are covered with copays ranging from $399 to $699, and routine hearing exams feature no copay. Additionally, durable medical equipment and dialysis services generally carry a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Value Choice H5216-451 (PPO) offers partially covered inpatient hospital benefits with no coinsurance, requiring a $332 daily copay for days 1 to 9 of acute stays and a $275 daily copay for days 1 to 9 of psychiatric stays, with no copay for subsequent covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Humana Value Choice H5216-451 (PPO) covers outpatient services with no coinsurance, including outpatient hospital care with a $0 to $250 copay and observation services with a $332 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Value Choice H5216-451 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Humana Value Choice H5216-451 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Value Choice H5216-451 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services each require a $115 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-451 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Other covered services, such as physical therapy ($20 copay) and mental health sessions ($35 copay), also feature no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Humana Value Choice H5216-451 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered, offering memory fitness and in-home support at no cost, while sub-services such as health education, weight management, personal emergency response systems, and alternative therapies are not covered.
Hearing Services See details
Humana Value Choice H5216-451 (PPO) features partially covered hearing services, including Medicare-covered exams for a $50 copay and routine exams or fittings with no copay and no coinsurance. Prescription hearing aids are covered with a $399 to $699 copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Value Choice H5216-451 (PPO) partially covers vision services with no coinsurance, featuring no copay for routine annual eye exams and select eyewear, and a $0 to $50 copay for other covered exams. There is no deductible, but a $150 annual eyewear limit applies, and other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Value Choice H5216-451 (PPO), featuring no copay and no coinsurance for most preventive and comprehensive care up to a $1,250 annual maximum, while Medicare-covered dental has a $50 copay and no coinsurance. However, fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Value Choice H5216-451 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Value Choice H5216-451 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Value Choice H5216-451 (PPO) covers 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.
Diagnostic and Radiological Services See details
Humana Value Choice H5216-451 (PPO) covers diagnostic services with no coinsurance, offering no copay for lab services and a copay ranging from $0 to $55 for diagnostic procedures. Covered radiological services include outpatient X-rays with no copay (coinsurance applies), diagnostic radiology with a $0 minimum copay, and therapeutic radiology with a minimum $50 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Value Choice H5216-451 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Value Choice H5216-451 (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and carry a $15 copay.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-451 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Humana Value Choice H5216-451 (PPO), featuring acupuncture with a $50 copay, no coinsurance, and a limit of 20 treatments per year. A chronic illness meal benefit is also covered with no copay and no coinsurance, though prior authorization is required for both services and over-the-counter (OTC) items are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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