2027 Medicare Advantage plan
Humana Value Plus H5216-180 (PPO): 2027 benefits and costs
Humana PPO
CMS plan ID: H5216-180-0 · Plan year: 2027
Humana Value Plus H5216-180 (PPO) is a 2027 Medicare Advantage plan offered by Humana. It is listed in Tennessee.
2027 plan costs at a glance
- Organization
- Humana
- Plan organization
- HUMANA INSURANCE COMPANY
- Parent company
- Humana Inc.
- Plan type
- PPO
- Part C premium
- $0.00
- Part D premium
- $13.70
- Prescription drug coverage
- Yes
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- Same as Medicare's Part B deductible
Applies to out-of-network Medicare-covered services and certain in-network Medicare-covered services; out-of-network $0 preventive care is exempt.
- In-network medical maximum
- $5,400.00
Applies to certain in-network supplemental services.
- Combined in/out-of-network medical maximum
- $7,400.00
Applies to certain in-network supplemental services.
- Out-of-network medical maximum
- Not applicable
2027 benefit summary
Doctor visits and medical care
Plan-level deductibles may still apply when a service-specific deductible is listed as No.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0.00 copay
| 40% coinsurance
| |
| Specialist visit | $20.00 copay
| 40% coinsurance
|
|
| Telehealth | $0.00 to $50.00 copay
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $130.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $50.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0.00 copay
| 40% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 30% coinsurance
|
|
| Other Part B drugs | $0.00 copay; 0% to 20% coinsurance
| $0.00 copay; 20% coinsurance
|
|
| Kidney disease education services | $0.00 copay
| $0.00 copay
|
|
| Medicare-covered chiropractic | $15.00 copay
| 40% coinsurance
|
|
| Medicare-covered foot care | $20.00 copay
| 40% coinsurance
|
|
| Other health professionals | $0.00 to $20.00 copay
| 40% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–5: $455.00 copay per day Days 6–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–5: $285.00 copay per day Days 6–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $218.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $180.00 copay
| $0.00 copay; 40% coinsurance
| |
| Hospital observation services | $455.00 copay
| $455.00 copay
| |
| Ambulatory surgical center | $0.00 to $105.00 copay
| $0.00 copay; 40% coinsurance
|
|
| Outpatient blood | $0.00 copay
| $0.00 copay
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $80.00 copay
| $50.00 copay; 40% coinsurance
|
|
| Laboratory services | $0.00 copay
| $50.00 copay; 40% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $335.00 copay
| $0.00 copay; 40% coinsurance
|
|
| Therapeutic radiology | $20.00 copay; 20% coinsurance
| 40% coinsurance
|
|
| X-rays | $0.00 to $125.00 copay
| $50.00 copay; 40% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $35.00 copay
| 40% coinsurance
|
|
| Intensive outpatient program | $35.00 copay
| 40% coinsurance
|
|
| Substance use treatment, individual sessions | $25.00 to $35.00 copay
| 40% coinsurance
|
|
| Substance use treatment, group sessions | $25.00 to $35.00 copay
| 40% coinsurance
|
|
| Opioid treatment program | $25.00 to $35.00 copay
| 40% coinsurance
|
|
| Mental health, individual sessions | $25.00 copay
| 40% coinsurance
|
|
| Mental health, group sessions | $25.00 copay
| 40% coinsurance
|
|
| Psychiatry, individual sessions | $25.00 copay
| 40% coinsurance
|
|
| Psychiatry, group sessions | $25.00 copay
| 40% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $20.00 copay
| 40% coinsurance
|
|
| Physical and speech therapy | $20.00 copay
| 40% coinsurance
|
|
| Cardiac rehabilitation | $20.00 copay
| 40% coinsurance
|
|
| Intensive cardiac rehabilitation | $20.00 copay
| 40% coinsurance
|
|
| Pulmonary rehabilitation | $20.00 copay
| 40% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $20.00 copay
| 40% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $325.00 copay
| $325.00 copay
|
|
| Air ambulance | 20% coinsurance
| 20% coinsurance
|
|
| Durable medical equipment | 20% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 40% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 40% coinsurance
|
|
| Diabetic supplies | $0.00 copay; 20% coinsurance
| $0.00 copay; 40% coinsurance
|
|
| Diabetic shoes and inserts | $10.00 copay
| 40% coinsurance
|
|
| Diabetic monitors | $0.00 copay; 20% coinsurance
| $0.00 copay; 40% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $20.00 copay | 40% coinsurance
| |
| Oral examsAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Restorative dental careAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Root canal treatment (endodontics)Additional plan benefit | $0.00 copay | $0.00 copay
| |
| Gum treatment (periodontics)Additional plan benefit | $0.00 copay | $0.00 copay
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | $0.00 copay | $0.00 copay
| |
| Oral surgeryAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Other dental servicesAdditional plan benefit | $0.00 copay | $0.00 copay
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0.00 to $20.00 copay
| $0.00 copay; 40% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Medicare-covered eyewear | $0.00 copay
| 40% coinsurance
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $20.00 copay
| 40% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay | 95% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0.00 copay | 95% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $0.00 copay
| 95% coinsurance
|
|
| Over-the-counter hearing aidsAdditional plan benefit | $0.00 copay
| 95% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Supplemental acupunctureAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| 95% coinsurance
| |
| Limited-duration mealsAdditional plan benefit | $0.00 copay
| 95% coinsurance
|
|
| Annual physical examAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
| Fitness benefitAdditional plan benefit | $0.00 copay
| 95% coinsurance
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Chiropractic ServicesAdditional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Routine Chiropractic CareAdditional plan benefit | Out-of-network | $0.00 copay
| |
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | $0.00 copay
|
|
| Transportation to plan-approved health locationsAdditional plan benefit | Out-of-network | 95% coinsurance
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | $0.00 copay
| |
| In-Home Support ServicesAdditional plan benefit | Out-of-network | 95% coinsurance
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | $0.00 copay
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | $0.00 copay
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | $0.00 copay
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | $0.00 copay
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | $0.00 copay; 20% coinsurance
|
Allowances and optional benefits
Healthy Options/OTC Allowance
One shared limit covers the listed services, not a separate allowance for each service.
- Services sharing this allowance
- Over-the-counter health items; Over-the-counter hearing aids; Additional Benefits for SSBCI
- Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s)
- Food and produce (SSBCI: Healthy Options Allowance); Pest control (SSBCI: Healthy Options Allowance); Transportation for non-medical needs (SSBCI: Healthy Options Allowance); Indoor Air Quality Equipment and Services (SSBCI: Healthy Options Allowance); Social support benefit (SSBCI: Healthy Options Allowance); Support for daily living (SSBCI: Healthy Options Allowance); Home and Bathroom Safety Devices and Modifications (SSBCI: Healthy Options Allowance); Personal emergency alert system (SSBCI: Healthy Options Allowance)
- How benefits are provided
- Debit Card
- Advance choice of benefits required
- No
- Shared benefit limit
- $540.00
- How often this limit applies
- Every year
- Are the benefits combined such that a single benefit maximum available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?
- Yes
- Shared limit on visits or trips
- No
- Are the benefits combined such that a single visit or trip limit available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?
- No
Benefits for qualifying members
Non-Emergency Medical Transportation
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Other 1; Other 2; Other 3
- Qualifying conditions
- End Stage Renal Disease (ESRD)
- Qualifying conditions
- Chronic Kidney Disease (CKD)
- Qualifying conditions
- Cancer
- All listed conditions required
- No
- Combination of conditions required
- No
- Included services
- Transportation to plan-approved health locations
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Services exempt from the deductible
- Transportation to plan-approved health locations
Nutritional Benefit
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Congestive Heart Failure (CHF)
- Included services
- Meal Benefit; Nutritional/Dietary Benefit
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Services exempt from the deductible
- Meal Benefit; Nutritional/Dietary Benefit
Virtual Cardiac Recovery Program
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Congestive Heart Failure (CHF); Hypertension; Other 1; Other 2
- Qualifying conditions
- Pneumonia
- Qualifying conditions
- Respiratory Illnesses
- All listed conditions required
- No
- Combination of conditions required
- No
- Included services
- Other 1
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Services exempt from the deductible
- Other 1
Healthy Options Allowance
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Conditions associated with cognitive impairment; Conditions with functional challenges; Other 1; Other 2
- Qualifying conditions
- Chronic Hyperlipidemia
- Qualifying conditions
- Chronic Hypertension
- Included services
- Food and produce; Pest control; Transportation for non-medical needs; Indoor Air Quality Equipment and Services; Social support benefit; Support for daily living; Home and Bathroom Safety Devices and Modifications; Personal emergency alert system
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Services exempt from the deductible
- Food and produce; Pest control; Transportation for non-medical needs; Indoor Air Quality Equipment and Services; Social support benefit; Support for daily living; Home and Bathroom Safety Devices and Modifications; Personal emergency alert system
- Package limit
- $0.00
- How often this limit applies
- Every year
- How benefits are provided
- Debit Card
- Services sharing the package limit
- Food and produce; Pest control; Transportation for non-medical needs; Indoor Air Quality Equipment and Services; Social support benefit; Support for daily living; Home and Bathroom Safety Devices and Modifications; Personal emergency alert system
Prescription drug coverage
Costs shown are for initial coverage.
This plan uses a non-tiered standard drug benefit; individual drug prices are not listed here.
| Pharmacy | Supply |
|---|---|
| Standard retail | 30 days |
| Standard retail | 100 days |
| Standard mail order | 30 days |
| Standard mail order | 100 days |
| Out-of-network pharmacy | 30 days |
| Long-term care pharmacy | 31 days |
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.
View all locations 81 county listings across 1 state or territory
Tennessee
- Anderson, Tennessee
- Benton, Tennessee
- Blount, Tennessee
- Bradley, Tennessee
- Campbell, Tennessee
- Cannon, Tennessee
- Carter, Tennessee
- Chester, Tennessee
- Claiborne, Tennessee
- Clay, Tennessee
- Cocke, Tennessee
- Crockett, Tennessee
- Cumberland, Tennessee
- Decatur, Tennessee
- DeKalb, Tennessee
- Dyer, Tennessee
- Fayette, Tennessee
- Fentress, Tennessee
- Franklin, Tennessee
- Gibson, Tennessee
- Giles, Tennessee
- Grainger, Tennessee
- Greene, Tennessee
- Grundy, Tennessee
- Hamblen, Tennessee
- Hamilton, Tennessee
- Hancock, Tennessee
- Hardeman, Tennessee
- Hardin, Tennessee
- Hawkins, Tennessee
- Haywood, Tennessee
- Henderson, Tennessee
- Henry, Tennessee
- Houston, Tennessee
- Humphreys, Tennessee
- Jackson, Tennessee
- Jefferson, Tennessee
- Johnson, Tennessee
- Knox, Tennessee
- Lake, Tennessee
- Lauderdale, Tennessee
- Lawrence, Tennessee
- Lewis, Tennessee
- Loudon, Tennessee
- Macon, Tennessee
- Madison, Tennessee
- Marion, Tennessee
- Maury, Tennessee
- McMinn, Tennessee
- McNairy, Tennessee
- Meigs, Tennessee
- Monroe, Tennessee
- Moore, Tennessee
- Morgan, Tennessee
- Obion, Tennessee
- Overton, Tennessee
- Perry, Tennessee
- Pickett, Tennessee
- Polk, Tennessee
- Putnam, Tennessee
- Rhea, Tennessee
- Roane, Tennessee
- Rutherford, Tennessee
- Scott, Tennessee
- Sequatchie, Tennessee
- Sevier, Tennessee
- Shelby, Tennessee
- Smith, Tennessee
- Stewart, Tennessee
- Sullivan, Tennessee
- Tipton, Tennessee
- Trousdale, Tennessee
- Unicoi, Tennessee
- Union, Tennessee
- Van Buren, Tennessee
- Warren, Tennessee
- Washington, Tennessee
- Weakley, Tennessee
- White, Tennessee
- Williamson, Tennessee
- Wilson, Tennessee