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Humana Value Plus H5216-173 (PPO) Medicare Advantage Plan H5216-173 • 2027 • Green Lake County, WI

CMS Rating: Not yet rated by CMS.
Monthly Premium
$6.30Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9850.00In-network
Part B Giveback
Not offered
Prescription Coverage
Basic, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Green Lake County, WI
Local Enrollment
0 beneficiaries in Green Lake County
Last update:

Humana Value Plus H5216-173 (PPO) Introduction

Humana Value Plus H5216-173 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 $6.30 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H5216-173 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.

You must live in Green Lake County, Wisconsin to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Green Lake County. For assistance with this plan, new members can call (888)873-0686 (TTY 711).

Compare Similar Plans in Green Lake County

Compare this plan with the two most-enrolled PPO plans available in Green Lake County, Wisconsin. Enrollment is based on CMS local enrollment data.

PPO plan comparison for Green Lake County, Wisconsin
Plan Detail Humana Value Plus H5216-173 Network Health Select Network Health Choice
CMS Plan ID H5216-173-0 H5215-008-0 H5215-011-0
Local Enrollment 0 1,234 643
Monthly Premium $6.30 $0.00 $0.00
Medical Deductible $0.00 $200 $500
Maximum Out-of-Pocket $9,850.00 $4,450.00 $5,100.00
Part B Giveback Not offered Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist 20% coinsurance $60 copay $50 copay
Part D Deductible $700.00 $330.00 $300.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental $0 copay $0 copay $0 copay
Vision $0 copay $10 copay $10 copay
Hearing $0 copay $0 copay $0 copay

Plan Benefits

Humana Value Plus H5216-173 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 H5216-173.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5216-173-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Out-of-network: 30% coinsurance
Specialist
In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Out-of-network: $0 copay
Telehealth benefit
In-network: $0-$35 copay, 20%-30% coinsurance
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Out-of-network: 95% coinsurance
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0-$345 copay, 20% coinsurance
Out-of-network: $0 copay, 50% coinsurance
Lab services
In-network: $0 copay
Out-of-network: 30%-50% coinsurance
Outpatient x-rays
In-network: $0-$40 copay, 20%-30% coinsurance
Out-of-network: 20%-50% coinsurance
Diagnostic tests and procedures
In-network: $0 copay, 20%-30% coinsurance
Out-of-network: 20%-50% coinsurance

Emergency and Urgent Care Services

Emergency room care
$115 copay
Worldwide emergency care
Coming soon
Urgent care
30% coinsurance
Inpatient hospital care
In-network:
Tier 1
$1,545 per stay
Out-of-network:
50% per stay
Skilled Nursing Facility
In-network:
Tier 1
$0 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: 30% coinsurance
Outpatient group therapy
In-network: $35 copay
Out-of-network: 30% coinsurance
Inpatient psychiatric hospital care
In-network:
Tier 1
$1,545 per stay
Out-of-network:
50% per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Occupational therapy
In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay, 20% coinsurance
Out-of-network: 10%-50% coinsurance
Durable medical equipment
In-network: 16% coinsurance
Out-of-network: 50% coinsurance
Prosthetics
In-network: 16% 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 copay, 0%-20% coinsurance
Out-of-network: $0 copay, 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
In-network: $0 copay
Out-of-network: $0 copay
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay

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: $0 copay
Out-of-network: 95% coinsurance
OTC hearing aids
In-network: $0 copay
Out-of-network: 95% coinsurance

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 Humana Value Plus H5216-173 as a Part B benefit.

Prescription Drug Coverage

Humana Value Plus H5216-173 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 a basic benefit Medicare Part D plan (PDP), meeting the minimum coverage requirements defined by CMS.

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.

Humana Value Plus H5216-173 (H5216-173-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:$6.30
Supplemental Part D Premium:$$0.00
Total Part D Premium:$6.30
Low-Income Premium Subsidy:$6.27
Low-Income Premium Subsidy Paid by CMS:$6.30
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, Humana Value Plus H5216-173 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Humana Value Plus H5216-173 (H5216-173-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Brand-name drugs25% coinsuranceComing soon
Generic drugs25% coinsuranceComing soon
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H5216)

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.

2027 Medicare Star Ratings for Contract H5216
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 ☆☆☆☆☆
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
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.

Official plan information and secondary Medicare references.
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 Compare Original Medicare & Medicare Advantage 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.