2022 HumanaChoice H5216-116 (PPO)

HumanaChoice H5216-116 (PPO) H5216-116 is a 2022 Medicare Advantage Plan or Part-C by Humana available to residents in Pennsylvania and New Jersey. This plan does not provide additional prescription drug (Part-D) coverage. The HumanaChoice H5216-116 (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,900 out-of-pocket. This can be a extremely nice safety net.

HumanaChoice H5216-116 (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HumanaChoice H5216-116 (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

2022 Humana Medicare Advantage Plan Costs

2021 HumanaChoice H5216-116 (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	55% coinsurance (Out-of-Network)
Extractions	50% coinsurance
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	55% coinsurance (Out-of-Network)
Restorative services	50% coinsurance

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$35-275 copay
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0 copay or 30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-95 copay
Lab services	30% coinsurance (Out-of-Network)
Lab services	$0-40 copay
Outpatient x-rays	30% coinsurance (Out-of-Network)
Outpatient x-rays	$0-95 copay

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Doctor Visits

Primary	$0 copay
Primary	30% coinsurance per visit (Out-of-Network)
Specialist	30% coinsurance per visit (Out-of-Network)
Specialist	$35 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$0-35 copay or 30% coinsurance per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	30% coinsurance (Out-of-Network)
Foot exams and treatment	$35 copay
Routine foot care	Not covered

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Ground Ambulance

$270 copay
$270 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$199-499 copay (Out-of-Network)
Hearing aids	$199-499 copay
Hearing exam	$35 copay
Hearing exam	30% coinsurance (Out-of-Network)

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Inpatient Hospital Coverage

30% per stay (Out-of-Network)
$275 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 91 and beyond

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Medical Equipment/Supplies

Diabetes supplies	30% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay or 10-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	30% coinsurance (Out-of-Network)
Other Part B drugs	30% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$275 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit	$35 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$35 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$35 copay
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$35 copay

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MOOP

$10,000 In and Out-of-network $3,900 In-network

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Option

No

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

30% coinsurance per visit (Out-of-Network)
$35-275 copay per visit

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Package #1

Deductible
Monthly Premium	$29.50

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Package #2

Deductible
Monthly Premium	$41.30

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Preventive Care

$0 copay or 30% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	50% coinsurance (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	50% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	$0 copay
Oral exam	50% coinsurance (Out-of-Network)

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Rehabilitation Services

Occupational therapy visit	$10-40 copay
Occupational therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$10-40 copay
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $178 per day for days 21 through 100
30% per stay (Out-of-Network)

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay (Out-of-Network)
Routine eye exam	$0 copay
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for HumanaChoice H5216-116 (PPO) H5216

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in HumanaChoice H5216-116 (PPO) Plans Performance

Health Plan Customer Service Rating for HumanaChoice H5216-116 (PPO)

HumanaChoice H5216-116 (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for HumanaChoice H5216-116 (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.