HumanaChoice H5216-266 (PPO)

Virginia Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost

by Humana

Additional Coverage

HearingVisionDental

Overall Government Star Rating

3.5

out of 5 stars

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Plan Name

HumanaChoice H5216-266 (PPO)

Insurance Carrier

Humana

Plan Type

Medicare Advantage Plan With Part D Prescription Drug Coverage

Network Type

PPO

HumanaChoice H5216-266 (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Virginia and offered by the health insurance company Humana. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium

Annual Deductible

Max Out-of-Pocket

$9,350

Primary doctor visit

$0 copay

Specialist visit

$15 copay per visit

ER visit

$110 copay per visit (always covered)

Ambulance

$315 copay

HumanaChoice H5216-266 (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $14,000 In and Out-of-network $9,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for HumanaChoice H5216-266 (PPO) are defined below.

Yes

Part D Prescription Drug Coverage

Yes

Dental

Yes

Vision

Yes

Hearing

HumanaChoice H5216-266 (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. HumanaChoice H5216-266 (PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. HumanaChoice H5216-266 (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit

Limited coverage

Over the counter drug benefits

Limited coverage

In-home support services

Not covered

Home and bathroom safety devices

Not covered

Meals for short duration

Limited coverage

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, HumanaChoice (PPO) received an overall government quality rating of 3.5 stars out of 5 stars.

HumanaChoice (PPO) performed worse than Virginia’s State average overall quality score of 3.8 stars.

This Plan’s 5-star Gov’t Quality Score

Virginia State Average Score

Overall Government 5 Star Quality Rating

3.5

3.8

Summary rating of health plan quality

3.5

3.7

Staying healthy: screenings, tests, & vaccines

3.7

Managing chronic (long term) conditions

3.4

Member experience with health plan

3.8

Member complaints & changes in the health plan's performance

4.3

Health plan customer service

4.0

Summary rating of drug plan quality

3.5

3.8

Drug plan customer service

4.2

Member complaints & changes in the drug plan's performance

4.1

Member experience with the drug plan

3.9

Drug safety & accuracy of drug pricing

3.2

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

HumanaChoice (PPO) received 3.5 stars for its health plan quality score which is worse than the Virginia State average health plan quality score of 3.7 stars.

HumanaChoice (PPO) received 3.5 stars for its drug plan quality score which is worse than the Virginia State average drug plan quality score of 3.8 stars.

Monthly Premium

Health Portion of Premium

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$14,000 In and Out-of-network
$9,350 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

https://www.humana.com/medicare?cm_mmc=provider_Medicare_gov-_-Medicare_gov_link-_-Vanity-_-Link

Plan Link

http://www.humana.com/medicare

Doctor Services

Primary doctor visit

In-network: $0 copay
Out-of-network: 50% coinsurance per visit

Specialist visit

In-network: $15 copay per visit
Out-of-network: 50% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $0-120 copay
Out-of-network: 50% coinsurance

Lab services

In-network: $0-50 copay
Out-of-network: 50% coinsurance

Diagnostic radiology services (like MRI)

In-network: $0-325 copay
Out-of-network: 50% coinsurance

Outpatient x-rays

In-network: $0-130 copay
Out-of-network: 50% coinsurance

Emergency care

$110 copay per visit (always covered)

Urgent care

$45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $399 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
Out-of-network: 50% per stay

Outpatient hospital coverage

In-network: $0-450 copay per visit
Out-of-network: 50% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$214 per day for days 21 through 100
Out-of-network: 50% per stay

Preventive services

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

Ambulance

Ground ambulance

In-network: $315 copay
Out-of-network: $315 copay

Therapy services

Occupational therapy visit

In-network: $25 copay
Out-of-network: 50% coinsurance

Physical therapy & speech & language therapy visit

In-network: $25 copay
Out-of-network: 50% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $45 copay
Out-of-network: 50% coinsurance

Outpatient individual therapy with a psychiatrist

In-network: $45 copay
Out-of-network: 50% coinsurance

Outpatient group therapy visit

In-network: $45 copay
Out-of-network: 50% coinsurance

Outpatient individual therapy visit

In-network: $45 copay
Out-of-network: 50% coinsurance

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item

Diabetes supplies

In-network: $0 copay or 10-20% coinsurance per item
Out-of-network: 50% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Tiers	Initial coverage phase	Catastrophic coverage phase
Preferred Generic	$0.00 copay	$0 copay
Generic	$5.00 copay	$0 copay
Preferred Brand	$47.00 copay	$0 copay
Non-Preferred Drug	45% coinsurance	$0 copay
Specialty Tier	28% coinsurance	$0 copay

Part B Drugs

Chemotherapy drugs

In-network: 0-20% coinsurance
Out-of-network: 50% coinsurance

Other Part B drugs

In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance