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HumanaChoice H5216-465 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-465 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-465 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-465 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Honolulu, Kauai, Maui. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-465 (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 H5216-465 (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 H5216-465 (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 $9200.00 (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 $9200.00 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 H5216-465 (PPO) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members enjoy no copay for both 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a low $5 copay for a 1-month supply at standard pharmacies or preferred mail order, and there is no copay for a 3-month supply when filled via preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, while a 3-month supply via preferred mail order lowers the cost to a $94 copay. For Tier 4 non-preferred drugs and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance. This plan provides a structured way to manage your medication expenses, offering the greatest savings when utilizing preferred mail-order services.
Additional Benefits
The HumanaChoice H5216-465 (PPO) plan offers robust core medical coverage with no copay or coinsurance for primary care visits and routine preventive services. Specialist visits require a $45 copay, while inpatient hospital stays cost a $375 copay for the first five days and no copay for days six through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. For supplemental care, this plan features dental benefits with no copay for preventive services up to a $1,000 annual limit, alongside routine vision and hearing exams with no copay. Prescription hearing aids require a copay of $599 to $899, and the plan provides a $300 yearly allowance for covered eyewear. Durable medical equipment and prosthetics are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by HumanaChoice H5216-465 (PPO) with no coinsurance, requiring a $375 copay for days 1 through 5 and no copay for days 6 through 90 per stay. Unlimited additional acute care days are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5216-465 (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $350, observation services have a $375 copay per stay, and outpatient substance abuse sessions carry a $25 to $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-465 (PPO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered under the HumanaChoice H5216-465 (PPO) plan with a $195 copay for ground transport and a $1,250 copay for air transport, with no coinsurance required for either. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
HumanaChoice H5216-465 (PPO) covers emergency services with a $130 copay and no coinsurance, and this copay is 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 each carry a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5216-465 (PPO) primary care benefits feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $45 copay and no coinsurance. Other covered services, including physical therapy, mental health, and telehealth, have copays ranging from $0 to $50 with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5216-465 (PPO) preventive services are partially covered, offering annual physical exams, kidney disease education, select screenings, and a memory fitness benefit with no copay and no coinsurance. However, several supplemental benefits, including health education, in-home safety assessments, and nutritional/dietary services, are not covered.
Hearing Services See details
HumanaChoice H5216-465 (PPO) hearing services are partially covered, offering Medicare-covered exams for a $45 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $599 to $899 for up to two aids per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
HumanaChoice H5216-465 (PPO) provides partially covered vision services with no coinsurance, featuring no copay for annual routine eye exams and covered eyewear up to a $300 yearly limit, though other eye exams carry a copay of up to $45. Covered eyewear includes contact lenses and eyeglasses (lenses and frames), but individual eyeglass lenses, eyeglass frames, upgrades, and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5216-465 (PPO), featuring an annual maximum benefit of $1,000 with no copay and no coinsurance for preventive care, and a $45 copay and no coinsurance for Medicare-covered dental. Covered restorative and periodontic services require a $25 copay and no coinsurance, but fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5216-465 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, require a coinsurance ranging from no coinsurance up to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
HumanaChoice H5216-465 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice H5216-465 (PPO) covers durable medical equipment (DME) and prosthetics with 20% coinsurance and no copay, though prior authorization is required. Covered diabetic supplies have no copay and 10% to 20% coinsurance, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5216-465 (PPO) with prior authorization, featuring no copay for lab and outpatient X-ray services. Diagnostic procedures and therapeutic radiological services require a 20% minimum coinsurance alongside copays of up to $200 for diagnostic tests, and a maximum copay limit applies to multiple services received on the same day.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5216-465 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HumanaChoice H5216-465 (PPO) with no copay, no coinsurance, and prior authorization required, although only some services are covered because standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-465 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
HumanaChoice H5216-465 (PPO) provides partially covered Other Services, featuring acupuncture for up to 20 treatments per year with a $45 copay and no coinsurance, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-Counter (OTC) items and other supplemental services are not covered under this plan.
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