2027 Medicare Advantage plan

HumanaChoice H5216-023 (PPO): 2027 benefits and costs

Humana PPO

CMS plan ID: H5216-023-0 · Plan year: 2027

HumanaChoice H5216-023 (PPO) is a 2027 Medicare Advantage plan offered by Humana.

2027 plan costs at a glance

Monthly plan premium$44.00
Drug deductible$450.00
In-network medical out-of-pocket maximum$6,000.00
Organization
Humana
Plan organization
HUMANA INSURANCE COMPANY
Parent company
Humana Inc.
Plan type
PPO
Part C premium
$13.00
Part D premium
$31.00
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
None
In-network medical maximum
$6,000.00

Applies to certain in-network supplemental services.

Combined in/out-of-network medical maximum
$10,000.00

Applies to certain in-network supplemental services.

Out-of-network medical maximum
Not applicable

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkOut-of-networkWhat to know
Primary care doctor

$0.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Specialist visit

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Telehealth

$0.00 to $50.00 copay

Service-specific deductible
No

Not summarized. Check coverage with the plan.

Approval required
No
Referral required
No
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

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Dialysis

20% coinsurance

Service-specific deductible
No

20% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No

20% to 50% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

$0.00 copay

Service-specific deductible
No

$0.00 copay

Deductible applies
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$15.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Medicare-covered foot care

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Other health professionals

$0.00 to $40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–5: $495.00 copay per day

Days 6–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–4: $495.00 copay per day

Days 5–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $10.00 copay per day

Days 21–100: $221.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkOut-of-networkWhat to know
Outpatient hospital care

$0.00 to $550.00 copay

Service-specific deductible
No

$0.00 copay; 50% coinsurance

Deductible applies
No
Hospital observation services

$495.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Ambulatory surgical center

$0.00 to $450.00 copay

Service-specific deductible
No

$0.00 copay; 50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Outpatient blood

$0.00 copay

Service-specific deductible
No

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkOut-of-networkWhat to know
Diagnostic procedures and tests

$0.00 to $175.00 copay

Service-specific deductible
No

$50.00 copay; 50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Laboratory services

$0.00 copay

Service-specific deductible
No

$50.00 copay; 50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Diagnostic radiology (CT, MRI)

$0.00 to $780.00 copay

Service-specific deductible
No

$0.00 copay; 50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Therapeutic radiology

$40.00 copay; 20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
X-rays

$0.00 to $145.00 copay

Service-specific deductible
No

$50.00 copay; 50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkOut-of-networkWhat to know
Partial hospitalization

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Substance use treatment, group sessions

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Opioid treatment program

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Mental health, individual sessions

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Mental health, group sessions

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Psychiatry, individual sessions

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Psychiatry, group sessions

$35.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkOut-of-networkWhat to know
Occupational therapy

$30.00 to $40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Physical and speech therapy

$30.00 to $40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Cardiac rehabilitation

$15.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Intensive cardiac rehabilitation

$15.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Pulmonary rehabilitation

$15.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Supervised exercise for peripheral artery disease

$15.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkOut-of-networkWhat to know
Ground ambulance

$325.00 copay

Service-specific deductible
No

$325.00 copay

Deductible applies
No
Approval required
Yes
Air ambulance

$1,800.00 copay

Service-specific deductible
No

$1,800.00 copay

Deductible applies
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Medical supplies

20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic supplies

$0.00 copay; 10% to 20% coinsurance

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic shoes and inserts

$10.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Diabetic monitors

$0.00 copay; 10% to 20% coinsurance

Service-specific deductible
No

20% to 50% coinsurance

Deductible applies
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkOut-of-networkWhat to know
Medicare-covered dental

$40.00 copay

50% coinsurance

Deductible applies
No
Oral examsAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Dental X-raysAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Dental cleaningAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Restorative dental careAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Root canal treatment (endodontics)Additional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Gum treatment (periodontics)Additional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Fixed dental restorations (prosthodontics)Additional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Oral surgeryAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Other dental servicesAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No

Additional network details

These costs apply to the listed service categories and networks.

Dental benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Diagnostic and preventive dental (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Comprehensive dental (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No

Vision benefits

Vision benefits and member costs
ServiceIn-networkOut-of-networkWhat to know
Medicare-covered eye exams

$0.00 to $40.00 copay

Service-specific deductible
No

$0.00 copay; 50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Routine eye examsAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Medicare-covered eyewear

$0.00 copay

Service-specific deductible
No

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Contact lensesAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0.00 copay

$0.00 copay

Deductible applies
No
Approval required
Yes
Referral required
No

Additional network details

These costs apply to the listed service categories and networks.

Vision benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Eye exams (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Eyewear (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkOut-of-networkWhat to know
Medicare-covered hearing exams

$40.00 copay

Service-specific deductible
No

50% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Routine hearing examsAdditional plan benefit

$0.00 copay

95% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Hearing aid fitting and evaluationAdditional plan benefit

$0.00 copay

95% coinsurance

Deductible applies
No
Approval required
Yes
Referral required
No
Prescription hearing aids (all types)Additional plan benefit

$575.00 to $750.00 copay

Service-specific deductible
No

95% coinsurance

Deductible applies
No
Approval required
No
Referral required
No
Over-the-counter hearing aidsAdditional plan benefit

$0.00 copay

Service-specific deductible
No

95% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No

Additional network details

These costs apply to the listed service categories and networks.

Hearing benefits: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Hearing exams (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No
Prescription hearing aids (category)Additional plan benefitOut-of-network

Confirm with the plan (copay); Confirm with the plan (coinsurance)

Dollar benefit limit applies
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkOut-of-networkWhat to know
Supplemental acupunctureAdditional plan benefit

$40.00 copay

Service-specific deductible
No

$40.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Over-the-counter health itemsAdditional plan benefit

$0.00 copay

Service-specific deductible
No

95% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Limited-duration mealsAdditional plan benefit

$0.00 copay

Service-specific deductible
No

95% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Annual physical examAdditional plan benefit

$0.00 copay

Service-specific deductible
No

$0.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No

95% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No

Additional services and network costs

Additional network details

These costs apply to the listed service categories and networks.

Additional medical services: additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Medicare-covered preventive servicesMedicare-covered careOut-of-network

$0.00 copay

Deductible applies
No
Glaucoma ScreeningMedicare-covered careOut-of-network

$0.00 copay

Deductible applies
No
Diabetes Self-Management TrainingMedicare-covered careOut-of-network

$0.00 copay

Deductible applies
No
Digital Rectal ExamsMedicare-covered careOut-of-network

$0.00 copay

Deductible applies
No
EKG after a Welcome to Medicare visitMedicare-covered careOut-of-network

$0.00 copay

Deductible applies
No
Medicare Part B insulinMedicare-covered careOut-of-network

20% to 50% coinsurance

Deductible applies
No

Allowances and optional benefits

OTC Max 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
How benefits are provided
Debit Card
Advance choice of benefits required
No
Shared benefit limit
$50.00
How often this limit applies
Every three months
Shared limit on visits or trips
No

Benefits for qualifying members

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
No

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
No

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Standard retail costs

Standard retail: initial-coverage cost per prescription fill
Drug tier30 days100 days
Tier 1Preferred Generic

$0.00

$0.00

Tier 2Generic

$0.00

$0.00

Tier 3Preferred Brand

17%

17%

Tier 4Non-Preferred Drug

44%

44%

Tier 5Specialty Tier

28%

Not listed

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

Preferred mail order: initial-coverage cost per prescription fill
Drug tier30 days100 days
Tier 1Preferred Generic

$0.00

$0.00

Tier 2Generic

$0.00

$0.00

Tier 3Preferred Brand

17%

15%

Tier 4Non-Preferred Drug

44%

44%

Tier 5Specialty Tier

28%

Not listed

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier30 days100 days
Tier 1Preferred Generic

$10.00

$30.00

Tier 2Generic

$20.00

$60.00

Tier 3Preferred Brand

17%

17%

Tier 4Non-Preferred Drug

44%

44%

Tier 5Specialty Tier

28%

Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier31 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$0.00

Tier 3Preferred Brand

17%

Tier 4Non-Preferred Drug

44%

Tier 5Specialty Tier

28%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier30 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$0.00

Tier 3Preferred Brand

17%

Tier 4Non-Preferred Drug

44%

Tier 5Specialty Tier

28%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 2: Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 3: Preferred Brand

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 4: Non-Preferred Drug

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
No
Some longer-fill prescriptions require a one-month first fill
No

Tier 5: Specialty Tier

Drugs included in this tier
Part D Drugs Only
Initial-coverage prices also apply to drugs exempt from the deductible
Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 4 states or territories. Availability can vary by county and ZIP code.

View all locations 97 county listings across 4 states or territories

Indiana

Kentucky

Ohio

Pennsylvania