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HumanaChoice Florida H5216-072 (PPO)

H5216 - 072 - 0
3.5 out of 5 stars (3.5 / 5)

humana medicare provider logo

HumanaChoice Florida H5216-072 (PPO) is a Medicare Advantage Plan by Humana.

This page features plan details for 2025 HumanaChoice Florida H5216-072 (PPO) H5216 – 072 – 0 available in Central Florida.

Locations

HumanaChoice Florida H5216-072 (PPO) is offered in the following locations.

Charlotte County, Florida
Citrus County, Florida
Collier County, Florida

Click to see more locations

Plan Overview

HumanaChoice Florida H5216-072 (PPO) offers the following coverage and cost-sharing.

Insurer:Humana
Health Plan Deductible:$50 annual deductible
MOOP:$9,600 In and Out-of-network
$6,100 In-network
Drugs Covered:Yes

Ready to sign up for HumanaChoice Florida H5216-072 (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

HumanaChoice Florida H5216-072 (PPO) qualifies for a monthly Medicare Give Back Benefit of $1.50.

Premium Reduction:$1.50

Premium Breakdown

HumanaChoice Florida H5216-072 (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $1.50 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

HumanaChoice Florida H5216-072 (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $250.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $250.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

HumanaChoice Florida H5216-072 (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Limits Apply, Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Limits Apply, Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Other Preventive Dental Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay

Diagnostic procedures/lab services/imaging

  • Outpatient x-rays
    • In-Network: $5-40 copay or 20% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $65 copay or 50% coinsurance (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: $65 copay or 50% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-200 copay or 20% coinsurance (Authorization Required)
    • Out-of-Network: $65 copay or 50% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0-15 copay or 20% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-325 copay (Authorization Required)
  • Lab services
    • Out-of-Network: $65 copay or 50% coinsurance (Authorization Required)

Doctor visits

  • Specialist
    • In-Network: $40 copay per visit
  • Primary
    • In-Network: $5 copay per visit
    • Out-of-Network: $65 copay per visit
  • Specialist
    • Out-of-Network: $65 copay per visit

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $15 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $40 copay (Authorization Required)
    • Out-of-Network: $65 copay (Authorization Required)
  • Routine foot care
    • Not covered

Ground ambulance

    • In-Network: $120-240 copay
    • Out-of-Network: $120-240 copay

Health plan deductible

    • $50 annual deductible

Hearing

  • Hearing aids OTC
    • In-Network: $0 copay (Limits Apply)
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $40 copay (Authorization Required)
  • Hearing aids OTC
    • Out-of-Network: 25% coinsurance (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $65 copay (Authorization Required)
  • Fitting/evaluation
    • Out-of-Network: 25% coinsurance (Limits Apply, Authorization Required)
  • Hearing aids
    • Out-of-Network: 25% coinsurance (Limits Apply)

Inpatient hospital coverage

    • In-Network: $400 per day for days 1 through 7
      $0 per day for days 8 through 90
      $0 per day for days 91 and beyond (Authorization Required)
    • Out-of-Network: $495 per day for days 1 through 27
      $0 per day for days 28 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $9,600 In and Out-of-network
      $6,100 In-network

Medical equipment/supplies

  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 25% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: $0 copay or 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: $0 copay or 12% coinsurance per item (Authorization Required)
    • Out-of-Network: 30-50% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • Out-of-Network: $495 per day for days 1 through 27
      $0 per day for days 28 through 90 (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $65 copay (Authorization Required)
    • In-Network: $30 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $400 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $30 copay (Authorization Required)
    • Out-of-Network: $65 copay (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $30 copay (Authorization Required)
    • Out-of-Network: $65 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $30 copay (Authorization Required)
    • Out-of-Network: $65 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0-400 copay or 20% coinsurance per visit (Authorization Required)
    • Out-of-Network: $65 copay or 50% coinsurance per visit (Authorization Required)

Preventive care

    • Out-of-Network: $0 copay or 50% coinsurance
    • In-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • In-Network: $20-40 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $65 copay or 50% coinsurance (Authorization Required)
  • Occupational therapy visit
    • Out-of-Network: $65 copay or 50% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $20-40 copay (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: $250 per day for days 1 through 58
      $0 per day for days 59 through 100 (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $160 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Other
    • Not covered
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Eyeglass frames
    • Not covered
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply, Authorization Required)
    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply, Authorization Required)
    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)
  • Eyeglass lenses
    • Not covered
  • Routine eye exam
    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)
  • Upgrades
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for HumanaChoice Florida H5216-072 (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on HumanaChoice Florida H5216-072 (PPO)? See 2025 HumanaChoice Florida H5216-072 (PPO) at MedicareAdvantageRX.com.

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Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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