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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 $27.00. 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 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 $10100.00 (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 $10100.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply through standard pharmacies and preferred mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a 1-month supply, or 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 options, with savings available on 3-month preferred mail orders. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. This structure helps you budget effectively for your medication needs under this Humana PPO plan.
Additional Benefits
The Humana Value Choice H5216-456 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits and a low $10 copay for specialists. Hospital stays require no coinsurance, with inpatient care costing a $420 daily copay for days 1 to 5 and outpatient services ranging from no copay up to $420. Emergency room visits carry a $130 copay, which is waived if you are admitted within 24 hours. This plan also features strong supplemental coverage, including routine vision exams and dental services with no copay, alongside a $3,500 annual dental limit. Routine hearing exams also feature no copay, though prescription hearing aids require copays ranging from $699 to $999. For specialized needs, home health services have no copay, while dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Humana Value Choice H5216-456 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $420 copay for days 1 to 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, room 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, featuring a $0 to $420 copay for outpatient hospital services and a $420 copay per stay for observation services. There is no copay for ambulatory surgical center or outpatient blood services, while outpatient substance abuse sessions have a copay ranging from $0 to $35.
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 coverage for 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, with no coinsurance required for either service. While transportation is technically covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Humana Value Choice H5216-456 (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Value Choice H5216-456 (PPO) covers primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits require a $10 copay and no coinsurance. Physical, occupational, and speech therapy services have a $20 copay and no coinsurance, though podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Humana Value Choice H5216-456 (PPO) provides partial coverage for preventive services, offering annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. However, additional preventive benefits such as fitness programs, health education, and nutritional/dietary services are not covered.
Hearing Services See details
Humana Value Choice H5216-456 (PPO) covers hearing exams with a $10 copay for Medicare-covered visits and no copay for routine exams and fittings, all with no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Humana Value Choice H5216-456 (PPO) offers partially covered vision services with no deductibles and no coinsurance, though prior authorization is required. Eye exams carry a $0 to $10 copay (with no copay for routine exams) up to a $75 annual limit, and covered eyewear has no copay up to a $100 annual limit, but other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Value Choice H5216-456 (PPO) partially covers dental services up to a $3,500 annual limit, with a $10 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. However, fluoride treatments, maxillofacial prosthetics, implant services, 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. Associated Medicare Part B drugs, including chemotherapy and insulin, feature a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Humana Value Choice H5216-456 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Value Choice H5216-456 (PPO) covers medical equipment, including durable medical equipment (DME) 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 and coinsurance, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Humana Value Choice H5216-456 (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic tests, no copay for lab services or outpatient X-rays, and a $0 to $50 copay for diagnostic procedures. Diagnostic radiological services have copays starting at $0, while therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Value Choice H5216-456 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Humana Value Choice H5216-456 (PPO) plan require prior authorization and feature no coinsurance and a $10 copay. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Humana Value Choice H5216-456 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 70, and no copay for days 71 to 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Value Choice H5216-456 (PPO) partially covers other services, offering acupuncture for a $10.00 copay and no coinsurance for up to 20 treatments per year, alongside chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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