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HumanaChoice H5216-224 (PPO)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$16.80
Monthly Premium
HumanaChoice H5216-224 (PPO) is a PPO plan offered by Humana Inc.
Plan ID: H5216-224
HelpAdvisor Editorial Team analysis of data from the 2027 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as HumanaChoice H5216-224 (PPO) - H5216-224 by Humana Inc. as well as other Medicare Advantage plans available in your area.
$16.80
Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Drug Deductible | $500 |
| Out of Pocket Max | In-Network: $4150 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 |
| Specialty Doctor Visit | Out-of-Network: Doctor Specialty Visit Services: Copayment for Medicare Covered Physician Specialist Office Visit $80 |
| Inpatient Hospital Care | Out-of-Network: Acute Hospital Services: Coinsurance for Acute Hospital Services per Stay 30% |
| Urgent Care | Urgent Care: Copayment for Urgent Care $65 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $65 |
| Emergency Room Visit | Emergency Care: Copayment for Emergency Care $150 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $150 Copayment for Worldwide Emergency Transportation $325 |
| Ambulance Transportation | Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $325 Copayment for Medicare Covered Ambulance Services - Air $630 |
Health Care Services and Medical Supplies
HumanaChoice H5216-224 (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $20 Prior Authorization Required for Chiropractic Services Out-of-Network: Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $65 |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0 Coinsurance for Medicare-covered Diabetic Supplies 10% Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $10 |
| Durable Medical Equipment (DME) | Out-of-Network: Durable Medical Equipment Services: Coinsurance for Medicare Covered Durable Medical Equipment 50% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $150 Copayment for Medicare-covered Lab Services $0 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services $150 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$40 OP Diag Proc & Tests - SPC$65 OP Diag Proc & Tests - UCC$50 Sleep Study (Fac Based) - OPH$35 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 to $300 Copayment for Medicare-covered Therapeutic Radiological Services $40 Coinsurance for Medicare-covered Therapeutic Radiological Services 20% Copayment for Medicare-covered X-Ray Services $0 to $75 |
| Home Health Care | Out-of-Network: Home Health Services: Coinsurance for Medicare Covered Home Health 50% |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: $325 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental Health Outpatient Care | In-Network: Outpatient Mental Health Services: Copayment for Medicare-covered Individual Sessions $25 Copayment for Medicare-covered Group Sessions $25 |
| Outpatient Services / Surgery | Out-of-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $80 Coinsurance for Medicare Covered Outpatient Hospital Services 30% to 40% Copayment for Medicare Covered Ambulatory Surgical Center Services $0 Coinsurance for Medicare Covered Ambulatory Surgical Center Services 30% $0 Diag Colonoscopy - OPH$35 Mental Health - OPH$325 Surgery Svcs - OPH$40 Wound Care - OPH |
| Outpatient Substance Abuse Care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $25 to $35 Copayment for Medicare-covered Group Sessions $25 to $35 Prior Authorization Required for Outpatient Substance Abuse Services $35 OP Substance Abuse Care - OPH$25 OP Substance Abuse Care - SPC Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 40% Coinsurance for Medicare Covered Group Sessions 40% $35 OP Substance Abuse Care - OPH$25 OP Substance Abuse Care - SPC |
| Over-the-counter (OTC) Items | In-Network: $50 quarterly allowance to buy approved over-the-counter health and wellness products available through our OTC Mail Order provider. Unused amount rolls over to the next quarter and expires at the end of the plan year. Out-of-Network: 95% coinsurance for approved over-the-counter health and wellness products up to $50 quarterly allowance amount. Member is required to pay the full cost at the time of service when utilizing an out-of-network provider. To receive reimbursement from Humana for eligible items/services, the member must submit required documentation. Reimbursement will be limited to up to 5% of the allowed amount on eligible items/services. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
| Podiatry Services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $40 Copayment for Routine Foot Care $40
Out-of-Network: Podiatry Services: Copayment for Medicare Covered Podiatry Services $80 |
| Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: $20 per day for days 1 to 20 $218 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network: 0% coinsurance for crown recementation up to 1 every 2 years. 0% coinsurance for root canal retreatment up to 1 per tooth per lifetime. 0% coinsurance for bridge recementation up to 1 per year. 0% coinsurance for oral surgery up to 2 per year. 0% coinsurance for periodontal maintenance up to 4 per year. $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays up to 1 per year. $0 copayment for emergency diagnostic exam, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for intraoral x-rays up to 6 per year. 50% coinsurance for amalgam and/or composite filling up to 1 per tooth per surface every 2 years. 50% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. 50% coinsurance for occlusal adjustment up to 1 every 3 years. 50% coinsurance for crown-porcelain fused to high noble metal, crown-porcelain fused to noble metal, crown-porcelain/ceramic, denture repair - additions, other restorative services - core buildup and prefabricated post and core up to 1 per tooth every 5 years. 50% coinsurance for bridges-pontic, complete dentures, partial dentures up to 1 every 5 years. 50% coinsurance for bridges-crown-porcelain fused to high noble metal, bridges-crown-porcelain fused to noble metal, bridges-crown-porcelain/ceramic up to 2 every 5 years. 50% coinsurance per tooth for root canal, simple or surgical extraction up to 1 per lifetime. 50% coinsurance for necessary nitrous oxide/analgesia with covered service up to 1 unit(s) per visit. 50% coinsurance for denture rebase, denture reline, scaling for moderate inflammation, tissue conditioning up to 1 per year. 50% coinsurance for denture repair - broken teeth up to 2 per tooth per year. 50% coinsurance for adjustments to dentures, denture repair - base and framework, emergency treatment for pain, necessary general anesthesia with covered service up to 2 per year. 50% coinsurance for necessary incremental anesthesia with covered service up to as needed with covered codes per year. $2,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. Out-of-Network: 0% coinsurance for crown recementation up to 1 every 2 years. 0% coinsurance for root canal retreatment up to 1 per tooth per lifetime. 0% coinsurance for bridge recementation up to 1 per year. 0% coinsurance for oral surgery up to 2 per year. 0% coinsurance for periodontal maintenance up to 4 per year. $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays up to 1 per year. $0 copayment for emergency diagnostic exam, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for intraoral x-rays up to 6 per year. 50% coinsurance for amalgam and/or composite filling up to 1 per tooth per surface every 2 years. 50% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. 50% coinsurance for occlusal adjustment up to 1 every 3 years. 50% coinsurance for crown-porcelain fused to high noble metal, crown-porcelain fused to noble metal, crown-porcelain/ceramic, denture repair - additions, other restorative services - core buildup and prefabricated post and core up to 1 per tooth every 5 years. 50% coinsurance for bridges-pontic, complete dentures, partial dentures up to 1 every 5 years. 50% coinsurance for bridges-crown-porcelain fused to high noble metal, bridges-crown-porcelain fused to noble metal, bridges-crown-porcelain/ceramic up to 2 every 5 years. 50% coinsurance per tooth for root canal, simple or surgical extraction up to 1 per lifetime. 50% coinsurance for necessary nitrous oxide/analgesia with covered service up to 1 unit(s) per visit. 50% coinsurance for denture rebase, denture reline, scaling for moderate inflammation, tissue conditioning up to 1 per year. 50% coinsurance for denture repair - broken teeth up to 2 per tooth per year. 50% coinsurance for adjustments to dentures, denture repair - base and framework, emergency treatment for pain, necessary general anesthesia with covered service up to 2 per year. 50% coinsurance for necessary incremental anesthesia with covered service up to as needed with covered codes per year. $2,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | Out-of-Network: Eye Exams Services: Copayment for Medicare Covered Eye Exams $0 to $80 Coinsurance for Medicare Covered Eyewear 40% $0 Diab Eye Exam - All POTs$40 Vision Svcs (MC) - SPC |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | Out-of-Network: Hearing Exams Services: Copayment for Medicare Covered Hearing Exams $80 |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit |
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