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HumanaChoice H5216-439 (PPO)

Health Insurance Company: Humana

Medicare Advantage Plan Details

Humana
$0 /mo
monthly premium
HumanaChoice H5216-439 (PPO)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Dental
  • Vision
  • Hearing
3.5
out of 5 stars

General Plan Details

Medical Deductible
$1000
Out-of-Pocket Maximum
$6750
Rx Drug Coverage
Yes
Rx Deductible
$300
Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$45 copay per visit

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
No
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: $0 copay
Out-of-network: $30 copay per visit
Specialist Office Visit
In-network: $45 copay per visit
Out-of-network: $75 copay per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0 copay or 50% coinsurance

Emergency Room

$125 copay per visit (always covered)

Ambulance Coverage

In-network: $315 copay
Out-of-network: $315 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0-125 copay
Out-of-network: $30-75 copay or 40% coinsurance
Medicare-covered lab services: In-network: $0-45 copay
Out-of-network: $20-45 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0-350 copay
Out-of-network: 40% coinsurance
Medicare-covered x-ray services: In-network: $0-90 copay
Out-of-network: $30-130 copay

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $0-350 copay per visit
Out-of-network: $95 copay or 40% coinsurance per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $350 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: $500 per day for days 1 through 5
$0 per day for days 6 through 90
Inpatient hospital psychiatric:
In-network: $350 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $500 per day for days 1 through 5
$0 per day for days 6 through 90

Rehabilitation Coverage

Occupational therapy services:
In-network: $45 copay
Out-of-network: $75 copay
Physical therapy and speech and language therapy services:
In-network: $45 copay
Out-of-network: $75 copay

Urgent Care Coverage

$45 copay per visit (always covered)

Skilled Nursing Facility (SNF)

In-network: $10 per day for days 1 through 20
$214 per day for days 21 through 100
Out-of-network: 40% per stay

Mental Health Coverage

Medicare-covered individual sessions: In-network: $45 copay
Out-of-network: $75 copay
Medicare-covered group sessions: In-network: $45 copay
Out-of-network: $75 copay

Dental, Vision, Hearing Benefits

Dental Services

Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay

Vision Benefits

Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: $0 copay
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses: In-network: $0 copay
Out-of-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $45 copay
Out-of-network: $75 copay
Hearing aids:
Hearing aids (all types): In-network: $0-599 copay
Out-of-network: $0-599 copay

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$5.00 copay (30-day supply)
$15.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

40% coinsurance (30-day supply)
40% coinsurance (90-day supply)

Tier 5: Specialty Tier

29% coinsurance (30-day supply)

Tier 1: Preferred Generic

$10.00 copay (30-day supply)
$30.00 copay (90-day supply)

Tier 2: Generic

$20.00 copay (30-day supply)
$60.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

40% coinsurance (30-day supply)
40% coinsurance (90-day supply)

Tier 5: Specialty Tier

29% coinsurance (30-day supply)

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$5.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$94.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

40% coinsurance (30-day supply)
40% coinsurance (90-day supply)

Tier 5: Specialty Tier

29% coinsurance (30-day supply)

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
No
Acupuncture
Yes
Massage Therapy
No
Health Education
No
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
No
In-home support services
No
Home and bathroom safety devices
No
Meals for short duration
Yes

Plan Links

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Additional Plan Info

Plan Year:
2025
Insurance Company Website:
Humana

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield
  • Aspire Health Plan
  • Baylor Scott & White Health Plan
  • Capital Blue Cross
  • Cigna Healthcare
  • Dean Health Plan
  • Devoted Health
  • Florida Blue Medicare
  • Freedom Health
  • GlobalHealth
  • Health Care Service Corporation
  • Healthy Blue
  • HealthSun
  • Humana
  • Molina Healthcare
  • Mutual of Omaha
  • Medica Central Health Plan
  • Optimum HealthCare
  • Premera Blue Cross
  • SCAN Health Plan
  • Simply
  • UnitedHealthcareⓇ
  • Wellcare
  • WellPoint