HumanaChoice H5216-461 (PPO) Medicare Advantage Plan H5216-461 • 2027
- Monthly Premium
- $36.30Plus Part B premium.
- Medical Deductible
- Coming soon
- Maximum Out-of-Pocket
- $9250.00In-network
- Part B Giveback
- Coming soon
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- None
- Service Area
- See List
- Total Enrollment
- 94 beneficiaries
HumanaChoice H5216-461 (PPO) Introduction
HumanaChoice H5216-461 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 $36.30 monthly premium, Coming soon medical deductible, and $9250.00 in-network maximum out-of-pocket. CMS Plan ID H5216-461 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
Plan Benefits
HumanaChoice H5216-461 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 H5216-461.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | Coming soon | In-network: $0 copay Out-of-network: 30% coinsurance |
| Specialist | Coming soon | In-network: $35 copay Out-of-network: 30% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Coming soon | In-network: $0 copay |
| Telehealth benefit | Coming soon | In-network: $0-$40 copay |
| Routine chiropractic | Coming soon | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Health education | Coming soon | Not covered |
| Counseling services | Coming soon | Not covered |
| Over-the-counter drug benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | Coming soon | In-network: $0-$335 copay Out-of-network: $0 copay, 30% coinsurance |
| Lab services | Coming soon | In-network: $0-$40 copay Out-of-network: $40 copay, 30% coinsurance |
| Outpatient x-rays | Coming soon | In-network: $0-$125 copay Out-of-network: $40 copay, 30% coinsurance |
| Diagnostic tests and procedures | Coming soon | In-network: $0-$100 copay Out-of-network: $40 copay, 30% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | Coming soon | $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | Coming soon | $40 copay |
| Inpatient hospital care | Coming soon | In-network: Tier 1 $360 per day for days 1-7 $0 per day for days 8-90 $0 per stay Out-of-network: 30% per stay |
| Skilled Nursing Facility | Coming soon | In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 30% per stay |
| Ground ambulance | Coming soon | In-network: $335 copay Out-of-network: $335 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | Coming soon | In-network: $35 copay Out-of-network: 30% coinsurance |
| Outpatient group therapy | Coming soon | In-network: $35 copay Out-of-network: 30% coinsurance |
| Inpatient psychiatric hospital care | Coming soon | In-network: Tier 1 $360 per day for days 1-7 $0 per day for days 8-90 $0 per stay Out-of-network: 30% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | Coming soon | In-network: $20-$35 copay Out-of-network: 30% coinsurance |
| Occupational therapy | Coming soon | In-network: $20-$35 copay Out-of-network: 30% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | Coming soon | In-network: $0 copay, 10%-20% coinsurance Out-of-network: 30% coinsurance |
| Durable medical equipment | Coming soon | In-network: $0 copay, 16% coinsurance Out-of-network: 30% coinsurance |
| Prosthetics | Coming soon | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | Coming soon | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
| Other Part B drugs (Medicare-covered) | Coming soon | In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Dental x-rays | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Cleaning | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Periodontics | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Endodontics | Coming soon | Not covered |
| Restorative services | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Implant services | Coming soon | Not covered |
| Orthodontics | Coming soon | Not covered |
| Oral/Maxillofacial surgery | Coming soon | Not covered |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Contact lenses | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass frames only | Coming soon | Not covered |
| Eyeglass lenses only | Coming soon | Not covered |
| Eyeglasses (frames & lenses) | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Upgrades | Coming soon | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Fitting/evaluation | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Prescription hearing aids | Coming soon | In-network: $699-$999 copay Out-of-network: $699-$999 copay |
| OTC hearing aids | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Coming soon | Not covered |
| Home-based palliative care | Coming soon | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Coming soon | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Coming soon | Not covered |
| Massage therapy | Coming soon | Not covered |
| Home/bathroom safety devices | Coming soon | Not covered |
Certain preventive services are covered 100% by HumanaChoice H5216-461 as a Part B benefit.
Prescription Drug Coverage
HumanaChoice H5216-461 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: | $36.30 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $36.30 |
| Low-Income Premium Subsidy: | $36.28 |
| Low-Income Premium Subsidy Paid by CMS: | $36.30 |
| Low-Income Subsidy Premium: | $0.00 |
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 H5216-461 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Cost data not available. | ||
| *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.
Plan Availability
HumanaChoice H5216-461 (H5216-461-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About HumanaChoice H5216-461 (PPO)
How much does plan H5216-461 cost per month?
The plan’s monthly premium is $36.30 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $9250.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for HumanaChoice H5216-461?
The 2027 CMS star rating for HumanaChoice H5216-461 is ★4.0 out of 5.
How many beneficiaries are enrolled in this plan?
CMS reports 94 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $700.00.
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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