HumanaChoice H5216-423 (PPO) Medicare Advantage Plan H5216-423 • 2026 • Dorchester County, SC
CMS Plan ID H5216-423 identifies the Medicare Advantage plan HumanaChoice H5216-423, a PPO Part C plan offered by Humana for the 2026 plan year. This plan uses a Preferred Provider Organization (PPO) provider network and comes with Part D prescription drug coverage.
HumanaChoice H5216-423 Overview
Plan Overview for
H5216-423-0
|
|
|---|---|
| CMS Plan ID: |
H5216-423-0
|
| Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: |
$0.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $250 |
| Maximum Out-of-Pocket: | $6750.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $450.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Dorchester County, SC |
| Enrollment (Nationwide): | 1,702 beneficiaries |
| Enrollment (CMS – Local) | 34 beneficiaries in Dorchester County |
| Provided By: | Humana |
Plan Details for HumanaChoice H5216-423
This Medicare Advantage MAPD PPO plan includes Medicare Part A and Part B services along with integrated prescription drug coverage. The monthly premium is $0.00, and the plan allows access to Medicare-approved providers, with lower costs when using in-network providers. The annual Part D deductible is $450.00.
Primary care visits have a $0 copay | Out-of-network: 50% coinsurance, and specialist visits come with a $35 copay | Out-of-network: 50% coinsurance. Urgent care services carry a $50 copay, and ground ambulance transportation is $335 copay | Out-of-network: $335 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6750.00. Once this limit is reached, in-network services are fully covered for the remainder of the year.
This plan is listed by CMS under Plan ID H5216-423. Cost-sharing details are provided below.
Out-of-Pocket Costs
Cost-sharing for HumanaChoice H5216-423 includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H5216-423.
Certain preventive services are covered 100% by HumanaChoice H5216-423 as a Part B benefit.
Prescription Drug Coverage
HumanaChoice H5216-423 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 Advantage coverage.
| Basic Part D Premium: | $0.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $35.66 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $450.00 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 H5216-423 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 | $0.00 copay | Coming soon |
| Preferred Brand | $47.00 copay | Coming soon |
| Non-Preferred Drug | 43% coinsurance | Coming soon |
| Specialty Tier | 27% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS Star Ratings
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 |
|---|---|
| 2026 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 |
What is the monthly premium for HumanaChoice H5216-423 (PPO)?
The plan’s monthly premium is $0.00 for 2026. The Part B premium is not included.
What is the MOOP for HumanaChoice H5216-423 in 2026?
The 2026 in-network MOOP is $6750.00. Once this limit is reached, covered in-network costs are fully covered.
What is the star rating for plan H5216-423 in 2026?
The 2026 CMS star rating for HumanaChoice H5216-423 is ★3.5 out of 5.
What is the total enrollment for plan H5216-423?
CMS reports 1,702 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2026?
For 2026, the prescription drug deductible is $450.00.
Contact Information for Humana
| Contact Type | Details |
|---|---|
| Website: | Humana Plan Page |
| New Members: | 1-888-873-0686 |
| Existing Members: | 1-800-457-4708 |
| Plan Address: | 101 E Main Street | Louisville, KY 40202 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | September 8, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Humana (official source) | http://www.humana.com/medicare | October 13, 2025 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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