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HumanaChoice H5216-466 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5216-466 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5216-466 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5216-466 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in GA, SC and AL. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5216-466 (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 H5216-466 (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 H5216-466 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $7.00. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $13900.00 (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 $13900.00 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 H5216-466 (PPO) Medicare plan features an Enhanced Alternative prescription drug benefit with an annual deductible of $615.00. During the initial coverage phase, preferred generic drugs require a $5.00 copay through standard pharmacies or preferred mail, while standard generics carry a $47.00 copay. Higher-tier medications require coinsurance, including 40% for preferred brands and 25% for non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy will pay $7.00 for Part D coverage.
Additional Benefits
The HumanaChoice H5216-466 (PPO) plan offers comprehensive coverage for everyday health needs, featuring no copay and no coinsurance for primary care visits, preventive services, and routine vision and dental exams. For inpatient hospital stays, members pay a $375 daily copay for the first several days with no coinsurance, while outpatient hospital services range from no copay to a $450 copay. Emergency room visits require a $115 copay, which is waived upon admission, and urgent care is available for a $40 copay. Specialist visits and physical therapy are highly accessible with copays ranging from $15 to $40 and no coinsurance. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, while home health services and the first 20 days of skilled nursing facility stays require no copay. Additionally, members can benefit from routine hearing exams and over-the-counter items at no copay.
Inpatient Hospital See details
HumanaChoice H5216-466 (PPO) partially covers inpatient hospital benefits with no coinsurance, requiring a $375 copay for days 1 to 7 of acute stays (no copay for days 8 to 999) and a $375 copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under HumanaChoice H5216-466 (PPO) are covered with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from no copay to $450, while observation services have a $375 copay per stay and substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice H5216-466 (PPO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HumanaChoice H5216-466 (PPO) covers 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 H5216-466 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by HumanaChoice H5216-466 (PPO), excluding podiatry and routine chiropractic care. Covered primary care physician visits require no copay and no coinsurance, while other services like specialist visits and physical therapy require copays ranging from $15 to $40 with no coinsurance.
Preventive Services See details
Preventive services are covered by HumanaChoice H5216-466 (PPO) with no copays and no coinsurance for services like annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit. However, the plan only partially covers additional preventive benefits, leaving services such as health education, weight management, and in-home support programs uncovered.
Hearing Services See details
Hearing services are covered by HumanaChoice H5216-466 (PPO), featuring no deductible, copay, or coinsurance for annual routine exams, fitting evaluations, and OTC hearing aids. Medicare-covered exams require a $40 copay with no coinsurance, and prescription hearing aids are partially covered with a $699 to $999 copay for up to two devices per year, though inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
HumanaChoice H5216-466 (PPO) covers routine eye exams with no copay and other eye exams with a copay of $0 to $40, requiring no coinsurance up to a $75 annual limit. Eyewear is partially covered with no copay or coinsurance up to a $150 yearly limit for contact lenses and full eyeglasses, though individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5216-466 (PPO) offers partially covered dental services, featuring no copay and no coinsurance for preventive care like exams, cleanings, and x-rays, and a $40 copay with no coinsurance for Medicare-covered dental services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, though restorative, endodontic, and periodontic services are available as optional supplemental benefits.
Home Infusion bundled Services See details
HumanaChoice H5216-466 (PPO) covers Home Infusion bundled Services, which require prior authorization and step therapy. Covered chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5216-466 (PPO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required before you can receive these services.
Medical Equipment See details
HumanaChoice H5216-466 (PPO) covers durable medical equipment with a 20% coinsurance and no copay, and diabetic supplies with a 10% to 20% coinsurance and no copay. Prosthetic devices and medical supplies require a 20% coinsurance, while diabetic therapeutic shoes or inserts carry a $10 copay, with prior authorization required for most services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by HumanaChoice H5216-466 (PPO), with prior authorization required for all services. Lab services and outpatient X-rays have no copay and no coinsurance, while diagnostic procedures cost a $0 to $120 copay (no coinsurance), diagnostic radiology costs up to a $335 copay (no coinsurance), and therapeutic radiology requires a $40 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5216-466 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
HumanaChoice H5216-466 (PPO) states that some services are covered for Cardiac Rehabilitation Services, but in practice, the benefit is not covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5216-466 (PPO) covers Skilled Nursing Facility (SNF) services with no copay for days 1 to 20, a $218 daily copay for days 21 to 100, and no coinsurance. The benefit is partially covered, as prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5216-466 (PPO) partially covers other services, offering acupuncture with a $40 copay and no coinsurance, as well as over-the-counter items with no copay and no coinsurance. Meal benefits and Dual Eligible SNPs with highly integrated services are not covered under this plan.
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