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Humana Value Choice H5216-456 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Choice H5216-456 (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 H5216-456 (PPO) in 2026, please refer to our full plan details page.
Humana Value Choice H5216-456 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in UT. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Choice H5216-456 (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 H5216-456 (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 H5216-456 (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 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 $8950.00 (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 $8950.00 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 Humana Value Choice H5216-456 (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications are also highly affordable, costing a $5 copay for a 1-month supply at standard pharmacies or preferred mail order, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order services, though a 3-month supply through preferred mail order is slightly reduced to $131. Higher-tier medications carry coinsurance costs instead of flat copays, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. These structured costs help Humana Value Choice H5216-456 (PPO) members plan and manage their prescription drug expenses.
Additional Benefits
The Humana Value Choice H5216-456 (PPO) plan offers affordable coverage for everyday healthcare needs, featuring no copays or coinsurance for primary care visits and routine preventive services. Specialist visits require a low $10 copay, while inpatient hospital stays carry a $395 daily copay for the first five days and no copay for days six through 90. Emergency care is accessible with a $115 copay, which is waived if you are admitted, while urgently needed services have a $50 copay. This plan also provides robust supplemental benefits, including dental coverage up to a $3,500 annual limit with no copays or coinsurance for most preventive and comprehensive services. Routine vision and hearing exams are covered with no copays, and members benefit from no copays on home health services, laboratory tests, and over-the-counter items. Additionally, medical equipment and dialysis services are covered with coinsurance ranging from 10% to 20% and no copays.
Inpatient Hospital See details
Humana Value Choice H5216-456 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $395 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Value Choice H5216-456 (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $395 and observation services with a $395 copay per stay. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services carry a copay of $0 to $35 per session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Value Choice H5216-456 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Value Choice H5216-456 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both featuring no coinsurance and requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Value Choice H5216-456 (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 are available with a $115 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-456 (PPO) provides partially covered primary care benefits, featuring no copay and no coinsurance for primary care visits, and a $10 copay with no coinsurance for specialist visits. Physical, occupational, and speech therapies require a $25 copay with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Humana Value Choice H5216-456 (PPO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness benefit with no copay, while sub-services such as health education, nutritional training, and in-home safety assessments are not covered.
Hearing Services See details
Humana Value Choice H5216-456 (PPO) offers partially covered hearing services with no deductibles and no coinsurance, featuring a $10 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids require a copay ranging from $699 to $999, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Humana Value Choice H5216-456 (PPO) partially covers vision services with no coinsurance, featuring no copay for routine eye exams and covered eyewear, which are subject to annual limits of $75 and $250 respectively. There is no deductible, but other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Value Choice H5216-456 (PPO) with a $3,500 annual maximum benefit, featuring no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $10 copay and no coinsurance, while fluoride treatments, implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Value Choice H5216-456 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs require no copay and carry no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Value Choice H5216-456 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Value Choice H5216-456 (PPO) covers medical equipment, including durable medical equipment (DME) and prosthetics with a 15% 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
Humana Value Choice H5216-456 (PPO) covers diagnostic and radiological services, featuring no coinsurance and no copay for lab services, alongside a $0 to $50 copay for diagnostic procedures. Diagnostic radiological services carry a copay starting at $0, outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the Humana Value Choice H5216-456 (PPO) plan with no copay and no coinsurance. Prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services under the Humana Value Choice H5216-456 (PPO) require prior authorization and feature no coinsurance, though only some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-456 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 66 to 100, and a $218 daily copay for days 21 to 65. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Humana Value Choice H5216-456 (PPO) covers acupuncture with a $10.00 copay and no coinsurance for up to 20 treatments yearly, with prior authorization required. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, while some other services are not covered.
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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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