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HumanaChoice H5216-451 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-451 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-451 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5216-451 (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 H5216-451 (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 HumanaChoice 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 HumanaChoice 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 $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 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. 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 H5216-451 (PPO) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay a $10 copay for preferred generic drugs at preferred and standard mail pharmacies. For preferred brand drugs, you will pay 45% coinsurance at all pharmacies.
Additional Benefits
The HumanaChoice H5216-451 (PPO) plan offers a range of benefits with varying cost-sharing. The plan includes coverage for inpatient and outpatient services, with copays ranging from $0 to $350. Primary care visits have a $5 copay, while specialist visits cost $50. Additional benefits include hearing and vision services, with copays for exams and hearing aids, and dental services with a $1000 annual maximum. The plan also covers ambulance, emergency, and home health services, as well as medical equipment, with various cost-sharing amounts, and does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a $332 copay for days 1-10, and no copay for days 11-90, and Inpatient Hospital Psychiatric with a $275 copay for days 1-10, and no copay for days 11-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. 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 for HumanaChoice H5216-451 (PPO) includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $350, observation services have a $332 copay, and ambulatory surgical center services and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $35.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5216-451 (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 by the HumanaChoice H5216-451 (PPO) plan, with a $315 copay for ground ambulance services, and a 20% coinsurance for air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $55 copay; all services have no coinsurance.
Primary Care See details
The HumanaChoice H5216-451 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and occupational therapy services with a $23 copay. It also covers physician specialist services with a $50 copay, mental health specialty services, psychiatric services, and opioid treatment program services with a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $23 copay, and telehealth services range from no copay to a $55 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services including fitness benefit with no copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Health education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $50 copay, and routine hearing exams are covered with no copay for one exam per year, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with prescription hearing aids (all types) covered with a copay between $399 and $699 for two hearing aids every year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5216-451 (PPO) plan covers vision services including eye exams with a copay of $0-$50, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including a $50 copay for Medicare Dental Services and no copay for Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, and Periodontics, with a maximum plan benefit of $1000 per year. Fluoride Treatment, Endodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice H5216-451 (PPO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5216-451 (PPO) plan, with a coinsurance between 20% and 20% and prior authorization required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no coinsurance and no copay, Prosthetic Devices with no coinsurance and no copay, and Diabetic Equipment, including Diabetic Supplies with 5% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with 5% coinsurance and a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $55, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $325, Therapeutic Radiological Services have a copay of at least $50 and up to $55, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5216-451 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H5216-451 (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered. For days 1-20, there is a $20 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for HumanaChoice H5216-451 (PPO) includes acupuncture, which has a $50 copay, and 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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