A non-government entity
HumanaChoice H5216-457 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-457 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-457 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-457 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in MT. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-457 (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 H5216-457 (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 H5216-457 (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.
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 $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 $8500.00 (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 $8500.00 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:
Sign up for HumanaChoice H5216-457 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5216-457 (PPO) prescription drug plan features an annual drug deductible of $400. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a 1-month supply, with no copay required for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options. For higher-tier medications, Tier 4 non-preferred drugs have a 50% coinsurance, while Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply. These structured copays and coinsurance rates help you easily plan your healthcare budget with this Medicare PPO plan.
Additional Benefits
The HumanaChoice H5216-457 (PPO) plan offers robust healthcare coverage with no copay or coinsurance for primary care visits, mental health services, and key preventive care. Specialist visits require a $40 copay, while emergency room services carry a $115 copay that is waived if you are admitted within 24 hours. For inpatient hospital stays, members pay a daily copay of $425 for days 1 through 5 of acute stays, with no copay for subsequent days. This plan also includes valuable supplemental benefits, such as dental coverage with no copay up to a $3,000 annual limit and a $250 allowance for covered eyewear. Routine hearing exams have no copay, and prescription hearing aids are available with copays between $299 and $599. Additionally, home health care and diagnostic lab services require no copay, while durable medical equipment features a 14% coinsurance.
Inpatient Hospital See details
HumanaChoice H5216-457 (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $425 for days 1 through 5 of acute stays and $416 for days 1 through 5 of psychiatric stays, with no copay for subsequent covered days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5216-457 (PPO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0.00 to $495.00, observation services have a $425.00 copay per stay, and outpatient substance abuse sessions carry a copay of $0.00 to $35.00.
Partial Hospitalization See details
HumanaChoice H5216-457 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by HumanaChoice H5216-457 (PPO) with no coinsurance, requiring a $335 copay for ground transport and a $1,250 copay for air transport. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-457 (PPO) covers emergency services with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $50 copay. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay, and there is no coinsurance for any of these services.
Primary Care See details
HumanaChoice H5216-457 (PPO) features primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits require a $40 copay with no coinsurance. Physical, occupational, and speech therapies have a $30 copay with no coinsurance, but podiatry is not covered. Some chiropractic services are covered, though routine and other chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-457 (PPO) covers key preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness program with no copay but excluding services like health education, weight management, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5216-457 (PPO), featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Covered prescription hearing aids require no coinsurance with copays between $299 and $599 for up to two devices per year, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5216-457 (PPO) offers partially covered vision services with no coinsurance, featuring a $0 to $40 copay for eye exams and no copay for covered eyewear up to a $250 annual limit. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, other eye exam services, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-457 (PPO) partially covers dental services, offering Medicare-covered dental with a $40 copay and no coinsurance, as well as other covered dental services with no copay and no coinsurance up to a $3,000 annual maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
HumanaChoice H5216-457 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-457 (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HumanaChoice H5216-457 (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies with a 14% 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 no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-457 (PPO) with prior authorization required. Outpatient diagnostic tests feature no coinsurance and a copay of $0 to $95, lab services and 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 HumanaChoice H5216-457 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under HumanaChoice H5216-457 (PPO), but only some services are covered in practice. Standard cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered and require prior authorization.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-457 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and days 71 to 100, and a $218 daily copay for days 21 to 70. Prior authorization is required and admission does not require a prior three-day hospital stay, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under HumanaChoice H5216-457 (PPO) are partially covered, featuring acupuncture with a $40 copay, no coinsurance, and a limit of 20 treatments per year, as well as chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved