2027 Medicare Advantage plan
HumanaChoice H5216-317 (PPO): 2027 benefits and costs
Humana PPO
CMS plan ID: H5216-317-0 · Plan year: 2027
HumanaChoice H5216-317 (PPO) is a 2027 Medicare Advantage plan offered by Humana. It is listed in Indiana, Kentucky.
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
- $0.00
- 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
- $150.00
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
- $7,150.00
Applies to certain in-network supplemental services.
- Combined in/out-of-network medical maximum
- $10,750.00
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
| 50% coinsurance
| |
| Specialist visit | $45.00 copay
| 50% 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
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Kidney disease education services | $0.00 copay
| $0.00 copay
|
|
| Medicare-covered chiropractic | $15.00 copay
| 50% coinsurance
|
|
| Medicare-covered foot care | $45.00 copay
| 50% coinsurance
|
|
| Other health professionals | $0.00 to $45.00 copay
| 50% 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: $530.00 copay per day Days 6–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–4: $530.00 copay per day Days 5–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 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 $650.00 copay
| $0.00 copay; 50% coinsurance
| |
| Hospital observation services | $530.00 copay
| 50% coinsurance
| |
| Ambulatory surgical center | $0.00 to $550.00 copay
| $0.00 copay; 50% 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 $175.00 copay
| $50.00 copay; 50% coinsurance
|
|
| Laboratory services | $0.00 copay
| 50% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $780.00 copay
| $0.00 copay; 50% coinsurance
|
|
| Therapeutic radiology | $45.00 copay; 20% coinsurance
| 50% coinsurance
|
|
| X-rays | $0.00 to $145.00 copay
| $50.00 copay; 50% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $35.00 copay
| 50% coinsurance
|
|
| Intensive outpatient program | $35.00 copay
| 50% coinsurance
|
|
| Substance use treatment, individual sessions | $35.00 copay
| 50% coinsurance
|
|
| Substance use treatment, group sessions | $35.00 copay
| 50% coinsurance
|
|
| Opioid treatment program | $35.00 copay
| 50% coinsurance
|
|
| Mental health, individual sessions | $35.00 copay
| 50% coinsurance
|
|
| Mental health, group sessions | $35.00 copay
| 50% coinsurance
|
|
| Psychiatry, individual sessions | $35.00 copay
| 50% coinsurance
|
|
| Psychiatry, group sessions | $35.00 copay
| 50% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $30.00 to $40.00 copay
| 50% coinsurance
|
|
| Physical and speech therapy | $30.00 to $40.00 copay
| 50% coinsurance
|
|
| Cardiac rehabilitation | $15.00 copay
| 50% coinsurance
|
|
| Intensive cardiac rehabilitation | $15.00 copay
| 50% coinsurance
|
|
| Pulmonary rehabilitation | $15.00 copay
| 50% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $15.00 copay
| 50% 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 | $1,800.00 copay
| $1,800.00 copay
|
|
| Durable medical equipment | 20% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | $0.00 copay; 10% to 20% coinsurance
| 20% to 50% coinsurance
|
|
| Diabetic shoes and inserts | $10.00 copay
| 50% coinsurance
|
|
| Diabetic monitors | $0.00 copay; 10% to 20% coinsurance
| 20% to 50% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $45.00 copay | 50% 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% to 30% coinsurance | 0% to 30% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Oral surgeryAdditional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Other dental servicesAdditional plan benefit | 30% coinsurance | 30% coinsurance
|
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 $45.00 copay
| $0.00 copay; 50% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Medicare-covered eyewear | $0.00 copay
| $0.00 copay
|
|
| 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 | $45.00 copay
| 50% 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 | $575.00 to $750.00 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 | $45.00 copay
| $45.00 copay
|
|
| 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 |
|---|---|---|---|
| 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
| |
| 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 | 50% coinsurance
|
Allowances and optional benefits
Benefits for qualifying members
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
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
Prescription drug coverage
Costs shown are for initial coverage.
Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.
Standard retail costs
| Drug tier | 30 days | 100 days |
|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 |
| Tier 2Generic | $4.00 | $12.00 |
| Tier 3Preferred Brand | 17% | 17% |
| Tier 4Non-Preferred Drug | 41% | 41% |
| Tier 5Specialty Tier | 25% | 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
| Drug tier | 30 days | 100 days |
|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 |
| Tier 2Generic | $4.00 | $0.00 |
| Tier 3Preferred Brand | 17% | 15% |
| Tier 4Non-Preferred Drug | 41% | 41% |
| Tier 5Specialty Tier | 25% | Not listed |
Standard mail order costs
| Drug tier | 30 days | 100 days |
|---|---|---|
| Tier 1Preferred Generic | $10.00 | $30.00 |
| Tier 2Generic | $20.00 | $60.00 |
| Tier 3Preferred Brand | 17% | 17% |
| Tier 4Non-Preferred Drug | 41% | 41% |
| Tier 5Specialty Tier | 25% | Not listed |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $4.00 |
| Tier 3Preferred Brand | 17% |
| Tier 4Non-Preferred Drug | 41% |
| Tier 5Specialty Tier | 25% |
Out-of-network pharmacy costs
| Drug tier | 30 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $4.00 |
| Tier 3Preferred Brand | 17% |
| Tier 4Non-Preferred Drug | 41% |
| Tier 5Specialty Tier | 25% |
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 2 states or territories. Availability can vary by county and ZIP code.
View all locations 97 county listings across 2 states or territories
Indiana
Kentucky
- Adair, Kentucky
- Allen, Kentucky
- Anderson, Kentucky
- Ballard, Kentucky
- Barren, Kentucky
- Bath, Kentucky
- Bell, Kentucky
- Bourbon, Kentucky
- Boyd, Kentucky
- Boyle, Kentucky
- Bracken, Kentucky
- Breathitt, Kentucky
- Breckinridge, Kentucky
- Bullitt, Kentucky
- Butler, Kentucky
- Calloway, Kentucky
- Carlisle, Kentucky
- Casey, Kentucky
- Christian, Kentucky
- Clark, Kentucky
- Clay, Kentucky
- Clinton, Kentucky
- Crittenden, Kentucky
- Edmonson, Kentucky
- Elliott, Kentucky
- Fayette, Kentucky
- Fleming, Kentucky
- Franklin, Kentucky
- Fulton, Kentucky
- Gallatin, Kentucky
- Garrard, Kentucky
- Graves, Kentucky
- Grayson, Kentucky
- Harlan, Kentucky
- Harrison, Kentucky
- Hart, Kentucky
- Henry, Kentucky
- Hickman, Kentucky
- Hopkins, Kentucky
- Jackson, Kentucky
- Jefferson, Kentucky
- Jessamine, Kentucky
- Johnson, Kentucky
- Knott, Kentucky
- Knox, Kentucky
- Larue, Kentucky
- Laurel, Kentucky
- Lawrence, Kentucky
- Lee, Kentucky
- Leslie, Kentucky
- Lewis, Kentucky
- Lincoln, Kentucky
- Livingston, Kentucky
- Logan, Kentucky
- Lyon, Kentucky
- Madison, Kentucky
- Magoffin, Kentucky
- Marion, Kentucky
- Martin, Kentucky
- Mason, Kentucky
- McCracken, Kentucky
- McCreary, Kentucky
- Meade, Kentucky
- Menifee, Kentucky
- Mercer, Kentucky
- Metcalfe, Kentucky
- Monroe, Kentucky
- Montgomery, Kentucky
- Morgan, Kentucky
- Muhlenberg, Kentucky
- Nelson, Kentucky
- Nicholas, Kentucky
- Oldham, Kentucky
- Owsley, Kentucky
- Perry, Kentucky
- Pike, Kentucky
- Powell, Kentucky
- Pulaski, Kentucky
- Robertson, Kentucky
- Rockcastle, Kentucky
- Rowan, Kentucky
- Russell, Kentucky
- Scott, Kentucky
- Simpson, Kentucky
- Spencer, Kentucky
- Taylor, Kentucky
- Todd, Kentucky
- Trigg, Kentucky
- Trimble, Kentucky
- Union, Kentucky
- Warren, Kentucky
- Washington, Kentucky
- Wayne, Kentucky
- Whitley, Kentucky
- Woodford, Kentucky