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Humana Full Access H5216-411 (PPO)

Health Insurance Company: Humana

Medicare Advantage Plan Details

Humana
$0 /mo
monthly premium
Humana Full Access H5216-411 (PPO)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Dental
  • Vision
  • Hearing
3.5
out of 5 stars

General Plan Details

Medical Deductible
$500
Out-of-Pocket Maximum
$4400
Rx Drug Coverage
Yes
Rx Deductible
$250
Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$40 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: $0 copay
Specialist Office Visit
In-network: $40 copay per visit
Out-of-network: $40 copay per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0 copay

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: $0-95 copay
Out-of-network: $0-95 copay
Medicare-covered lab services: In-network: $0 copay
Out-of-network: $0 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0-395 copay
Out-of-network: $0-395 copay
Medicare-covered x-ray services: In-network: $0-150 copay
Out-of-network: $0-150 copay

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $0-325 copay per visit
Out-of-network: $0-325 copay per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $395 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond
Out-of-network: $395 per day for days 1 through 7
$0 per day for days 8 through 90
Inpatient hospital psychiatric:
In-network: $310 per day for days 1 through 7
$0 per day for days 8 through 90
Out-of-network: $310 per day for days 1 through 7
$0 per day for days 8 through 90

Rehabilitation Coverage

Occupational therapy services:
In-network: $40 copay
Out-of-network: $40 copay
Physical therapy and speech and language therapy services:
In-network: $40 copay
Out-of-network: $40 copay

Urgent Care Coverage

$55 copay per visit (always covered)

Skilled Nursing Facility (SNF)

In-network: $10 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: $10 per day for days 1 through 20
$203 per day for days 21 through 100

Mental Health Coverage

Medicare-covered individual sessions: In-network: $40 copay
Out-of-network: $40 copay
Medicare-covered group sessions: In-network: $40 copay
Out-of-network: $40 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: $40 copay
Out-of-network: $40 copay
Hearing aids:
Hearing aids (all types): In-network: $699-999 copay
Out-of-network: $699-999 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

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

30% 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

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

30% 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)
$131.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

30% 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

Plan Link
Doctor Lookup
Drug Link

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Where This Plan is Available

State:
Iowa
Counties:
Adair, Adams, Allamakee, Appanoose, Audubon, Benton, Black Hawk, Boone, Bremer, Buena Vista, Butler, Calhoun, Carroll, Cass, Cedar, Cherokee, Chickasaw, Clarke, Clay, Clayton, Clinton, Crawford, Dallas, Davis, Decatur, Delaware, Des Moines, Dickinson, Dubuque, Fayette, Floyd, Franklin, Fremont, Greene, Grundy, Guthrie, Hamilton, Hancock, Hardin, Henry, Howard, Humboldt, Ida, Jackson, Jasper, Jefferson, Johnson, Jones, Keokuk, Linn, Louisa, Lucas, Lyon, Madison, Mahaska, Marshall, Mills, Mitchell, Monona, Monroe, Montgomery, Muscatine, Obrien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Polk, Pottawattamie, Poweshiek, Ringgold, Sac, Scott, Shelby, Sioux, Story, Tama, Union, Van Buren, Wapello, Warren, Washington, Wayne, Webster, Winnebago, Winneshiek, Woodbury, Worth, Wright
View all plans in your Iowa County

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