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HumanaChoice H5216-463 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-463 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-463 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-463 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Indianapolis Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-463 (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 H5216-463 (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 H5216-463 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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 $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 HumanaChoice H5216-463 (PPO) plan includes a $400 drug deductible before coverage begins. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic drugs also feature no copay for a 3-month supply when using preferred mail order, though standard pharmacies charge a $10 copay for a 1-month supply. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, with 3-month supplies costing $131 through preferred mail order or $141 through standard pharmacies. For specialty and non-preferred medications, Tier 4 drugs require a 48% coinsurance, while Tier 5 specialty drugs have a 28% coinsurance. These options allow you to choose between standard retail pharmacies and convenient mail-order services to manage your prescription costs.
Additional Benefits
The HumanaChoice H5216-463 (PPO) plan offers robust healthcare coverage with no copay for primary care visits, preventive services, and home health care. Specialist visits require a $55 copay, while emergency services carry a $130 copay, both with no coinsurance. For hospital stays, there is no coinsurance, though patients will pay a daily copay of $440 for the first few days of acute inpatient care before transitioning to no copay for subsequent days. This plan also features dental, vision, and routine hearing services with no copay, although annual limits apply for comprehensive dental care and prescription eyewear. Durable medical equipment requires a 20% coinsurance with no copay, and skilled nursing facility stays have daily copays starting at $10 for the first 20 days. Additionally, over-the-counter items and meal benefits are available to members with no copay.
Inpatient Hospital See details
HumanaChoice H5216-463 (PPO) covers inpatient hospital services with no coinsurance, requiring a $440 daily copay for days 1 to 6 for acute stays (with no copay for days 7 and beyond) and a $440 daily copay for days 1 to 5 for psychiatric stays (with no copay for days 6 to 90). Prior authorization is required, and non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5216-463 (PPO) with no coinsurance, featuring a $0 to $440 copay for outpatient hospital services and a $440 copay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse individual and group sessions carry a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice H5216-463 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-463 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5216-463 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-463 (PPO) offers primary care physician visits with no copay and specialist visits for a $55 copay, both with no coinsurance. Mental health services require a $35 copay and therapy services range from a $15 to $40 copay, both with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5216-463 (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes training, with no copay and no coinsurance. While memory fitness and chemotherapy-related wigs are covered with no copay and no coinsurance, other supplemental services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice H5216-463 (PPO), featuring a $55 copay and no coinsurance for Medicare-covered exams, while routine exams, fitting evaluations, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $399 to $999 and no coinsurance, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-463 (PPO) vision services are partially covered, featuring no copay, no coinsurance, and no deductible for routine eye exams and select eyewear. Covered benefits include one routine eye exam and one pair of contact lenses or eyeglasses per year up to a $350 combined annual limit, while other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-463 (PPO) offers partially covered dental services with no copay and no coinsurance for most preventive and comprehensive care up to a $3,500 yearly limit, while Medicare-covered dental services require a $55 copay and no coinsurance. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-463 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, incur a coinsurance ranging from no coinsurance to 20%, with insulin drugs having a $35 copay.
Dialysis Services See details
HumanaChoice H5216-463 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5216-463 (PPO) covers durable medical equipment (DME) and prosthetics with a 20% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts have a copay ranging from $0 to $10, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-463 (PPO), with no copay or coinsurance for lab services and no copay for outpatient X-rays. Diagnostic procedures and tests require a copay of $0 to $105 with no coinsurance, while therapeutic radiological services require a minimum $35 copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-463 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5216-463 (PPO) with no copay and no coinsurance, and require prior authorization. However, only some services are covered under this plan, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-463 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, and while a 3-day prior inpatient hospital stay is not required, additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5216-463 (PPO) covers acupuncture with a $55 copay and no coinsurance for up to 20 treatments per year, while over-the-counter items and meal benefits are available with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and certain other miscellaneous services are not covered.
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