HumanaChoice H5216-013 (PPO) Medicare Advantage Plan H5216-013 • 2027 • Morgan County, IL
- Monthly Premium
- $92.00Plus Part B premium.
- Medical Deductible
- $700
- Maximum Out-of-Pocket
- $6550.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Morgan County, IL
- Local Enrollment
- 30 beneficiaries in Morgan County
HumanaChoice H5216-013 (PPO) Introduction
HumanaChoice H5216-013 is a Medicare Advantage PPO plan offered by Humana. It uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $92.00 monthly premium, $700 medical deductible, and $6550.00 in-network maximum out-of-pocket. CMS Plan ID H5216-013 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
You must live in Morgan County, Illinois to enroll in this plan. CMS reports 30 beneficiaries enrolled in this plan in Morgan County. For assistance with this plan, new members can call (888)873-0686 (TTY 711).
Compare Similar Plans in Morgan County
Compare this plan with the two most-enrolled PPO plans available in Morgan County, Illinois. Enrollment is based on CMS local enrollment data.
| Plan Detail | HumanaChoice H5216-013 | HumanaChoice Giveback H5216-403 | HumanaChoice Giveback H7617-013 |
|---|---|---|---|
| CMS Plan ID | H5216-013-0 |
H5216-403-0 |
H7617-013-0 |
| Local Enrollment | 30 | 247 | 111 |
| Monthly Premium | $92.00 | $0.00 | $0.00 |
| Medical Deductible | $700 | $750 | $750 |
| Maximum Out-of-Pocket | $6,550.00 | $5,000.00 | $5,000.00 |
| Part B Giveback | Not offered | −$51.00 reduction | −$51.00 reduction |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $50 copay | $40 copay | $40 copay |
| Part D Deductible | $700.00 | $700.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
HumanaChoice H5216-013 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5216-013.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5216-013-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: 50% coinsurance - Specialist
- In-network: $50 copay
Out-of-network: 50% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay - Telehealth benefit
- In-network: $0-$50 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$345 copay
Out-of-network: $0 copay, 50% coinsurance - Lab services
- In-network: $0 copay
Out-of-network: $50 copay, 50% coinsurance - Outpatient x-rays
- In-network: $0-$145 copay
Out-of-network: $50 copay, 50% coinsurance - Diagnostic tests and procedures
- In-network: $0-$100 copay
Out-of-network: $50 copay, 50% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $50 copay
- Inpatient hospital care
- In-network:
Tier 1
$360 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
50% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$10 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
50% per stay - Ground ambulance
- In-network: $325 copay
Out-of-network: $325 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $35 copay
Out-of-network: 50% coinsurance - Outpatient group therapy
- In-network: $35 copay
Out-of-network: 50% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$360 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
50% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $40 copay
Out-of-network: 50% coinsurance - Occupational therapy
- In-network: $40 copay
Out-of-network: 50% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay, 10%-20% coinsurance
Out-of-network: 10%-50% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: $0 copay - Dental x-rays
- In-network: $0 copay
Out-of-network: $0 copay - Cleaning
- In-network: $0 copay
Out-of-network: $0 copay - Periodontics
- In-network: $0 copay
Out-of-network: $0 copay - Endodontics
- Not covered
- Restorative services
- In-network: $25 copay
Out-of-network: $25 copay - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $0 copay - Contact lenses
- In-network: $0 copay
Out-of-network: $0 copay - Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: $0 copay - Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: 95% coinsurance - Fitting/evaluation
- In-network: $0 copay
Out-of-network: 95% coinsurance - Prescription hearing aids
- In-network: $575-$750 copay
Out-of-network: 95% coinsurance - OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by HumanaChoice H5216-013 as a Part B benefit.
Prescription Drug Coverage
HumanaChoice H5216-013 includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $92.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $92.00 |
| Low-Income Premium Subsidy: | $7.61 |
| Low-Income Premium Subsidy Paid by CMS: | $7.60 |
| Low-Income Subsidy Premium: | $84.40 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Humana starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, HumanaChoice H5216-013 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $5.00 copay | Coming soon |
| Preferred Brand | 17% coinsurance | Coming soon |
| Non-Preferred Drug | 40% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5216)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Humana
- Website
- Humana Plan Page
- Providers
- Humana Providers Page
- Formulary
- Humana Formulary Page
- Pharmacy
- Humana Pharmacy Page
- New Member Health Plan Help
- (888)873-0686
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (888)873-0686
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Humana (official source) | http://www.humana.com/medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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