HumanaChoice PPO (h5216-043)

The HumanaChoice PPO is a Medicare Advantage (Medicare Part C) plan offered by Humana that uses a preferred provider organization (PPO). This network of preferred providers offers maximum coverage benefits. You can use doctors and other providers outside the network, but you will pay greater out-of-pocket costs.

Terry Turner, writer and researcher for RetireGuide
  • Written by
    Terry Turner

    Terry Turner

    Senior Financial Writer and Financial Wellness Facilitator

    Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).

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  • Edited By
    Lamia Chowdhury
    Lamia Chowdhury, editor for

    Lamia Chowdhury

    Financial Editor

    Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.

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  • Published: September 9, 2022
  • Updated: January 17, 2023
  • 4 min read time
  • This page features 4 Cited Research Articles
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APA Turner, T. (2023, January 17). HumanaChoice PPO (h5216-043). Retrieved June 2, 2023, from

MLA Turner, Terry. "HumanaChoice PPO (h5216-043).", 17 Jan 2023,

Chicago Turner, Terry. "HumanaChoice PPO (h5216-043)." Last modified January 17, 2023.

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HumanaChoice PPO Medicare CMS Star Ratings

It is not available in all states or counties.

The HumanaChoice PPO received four of five stars over all in the CMS Star Rating system for 2022. One star represents poor performance while five stars represents excellent performance.

2022 Overall Rating - 4 Stars

The U.S. Centers for Medicare & Medicaid Services issue Medicare Advantage ratings based on the experiences of people enrolled in Medicare Advantage and Medicare Part D prescription drug plans.

The overall rating is based on the individual ratings for the HumanaChoice PPO health and drug plans.

HumanaChoice PPO Health Plan Rating

The HumanaChoice PPO health plan received 4 1/2 out of five stars in the CMS Star Rating system,

Health Plan Rating - 4 and a Half Stars

It received five-star ratings in 10 of the 33 criteria Medicare uses to rate Medicare Advantage health plans.

HumanaChoice Health Plan 5-Star Ratings
  • Assessment of members’ health care needs and risks
  • Beneficiaries with diabetes whose blood sugar is under control
  • Colorectal screenings
  • Customer service
  • Low number of complaints about the plan
  • Timely decisions about appeals
  • Fairness of appeals decisions (made by an independent reviewer)
  • TTY and foreign language interpreters when calling the plan
  • Yearly pain screening and pain management
  • Yearly review of members’ drugs and supplements

The plan’s lowest rating was one for zero stars — for failing to provide information or help when a plan member requested it. It received two, two-star ratings — member rating of the plan and reducing the risk of falls.

But it also received 13 four-star ratings.

HumanaChoice PPO Drug Plan Rating

The HumanaChoice PPO prescription drug plan also received a 4 1/2 out of five stars from Medicare.

Prescription Drug Plan Rating - 4 and a Half Stars

It received five-star ratings for five of the 16 criteria Medicare uses to rate Medicare Advantage drug plans.

AARP Medicare Advantage (HMO-POS) Drug Plan 5-Star Ratings
  • Changes to the plan’s performance resulting from customer complaints
  • Customer service
  • Improvement to plan’s performance
  • Low number of complaints about the plan
  • TTY and foreign language interpretation services when beneficiaries call the plan

The lowest ratings the drug plan received were three-star ratings in three categories.

AARP Medicare Advantage (HMO-POS) Drug Plan 3-Star Ratings
  • Accurate drug pricing information provided through the Medicare Plan Finder website
  • Making sure beneficiaries with diabetes take the most effective drugs for high-cholesterol
  • Members’ rating of the plan

Costs and Coverage

In addition to a premium for the HumanaChoice PPO, you still have to pay the Medicare Part B medical insurance premium — $170.10 in 2022.

Example of In-Network Copay for HumanaChoice PPO, 2022
Medical Premiums$10
Medical DeductibleN/A
Drug Plan Premium$10
Prescription Deductible$250
Maximum Out-of-Pocket (in-network)$6,700
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Health Care Services and Durable Medical Equipment (DME) Coverage

The HumanaChoice PPO offers the same coverage as Original Medicare, but also includes extra benefits that Original Medicare does not cover.

Examples of Services and DME Coverage*
Ambulance services (ground only)$290$290
Diabetes supplies$0 copay or 10% – 20% of the item’s cost25% of the item’s cost
Diagnostic tests and procedures$0 – $175 copay$0 – $60 copay or 40% coinsurance
Diagnostic Radiology services (MRI, CT scans)$35 – $325 copay$65 copay or 40% coinsurance
Lab services$0 – $50 copay40% coinsurance
Outpatient X-rays$0 – $95 copay$25 – $65 copay or 40% coinsurance
Primary care visits$0 copay$25 copay
Specialist visits$35 copay$65 copay
Durable medical equipment20% coinsurance per item20% – 40% coinsurance per item
Prosthetics20% coinsurance per item25% coinsurance per item
Emergency care$90 copay$90 copay
Urgent Care$0 – $65 copay or 40% coinsurance $0 – $65 copay or 40% coinsurance
Inpatient hospital care$31 per day for days 1 – 5 $0 per day for days 6 – 90 $475 per day for days 1 – 25 $0 per day for days 26 – 90

Dental, Vision and Hearing Benefits

Like many Medicare Advantage plans, the HumanaChoice PPO offers hearing, vision and dental benefits as part of its coverage.

Examples of Services and DME Coverage*
Dental services — oral exam$0 copay50% – 75% coinsurance
Dental cleaning0% – 70% coinsurance50% – 75% coinsurance
Dental — fluoride treatments$0 copay50% – 75% coinsurance
Dental X-rays$0 copay 50% – 75% coinsurance
Dental restorative services50% coinsurance55% – 75% coinsurance
Dental — periodontics70% coinsurance55% – 75% coinsurance
Dental extractions50% coinsurance55% – 75% coinsurance
Routine eye exam$0 copay $0 copay
Contact Lenses$0 copay $0 copay
Eyeglasses$0 copay $0 copay
Hearing exam$35 copay$65 copay
Hearing aids$699 – $999 copay $699 – $999 copay
Hearing aid fitting and evaluation$0 copay $0 copay

Prescription Drug Costs and Coverage

The HumanaChoice PPO includes a Medicare Part D drug plan which has a five-tier formulary.

It’s important to check before buying any Part D coverage to make sure that drugs you take are part of the plans’ formulary.

Copays by Tier, Supply and Pharmacy, 2022
Tier1 Month Preferred Retail 3 Month Preferred Retail1 Month Standard Retail3 Month Standard Retail1 Month Preferred Mail Order3 Month Preferred Mail Order1 Month Standard Mail Order3 Month Standard Mail Order
Tier 1 Preferred Generic$3$9$10$30$3$9$10$30
Tier 2 Generic $10$30$20$20$10$0 $20$60
Tier 3 Preferred Brand Name $47$141$47$141$47$131$47$141
Tier 4 Non- Preferred Drug $99$297$199$300$99$287$100$300
Tier 5 Specialty Drugs 28% N/A28% N/A28% N/A28% N/A

Gap coverage kicks in once your total costs paid by the plan and you — out of your own pocket — total $4,430. After that — and up until you hit the MOOP threshold of $6,350 — you pay 25% for both generic and brand name drugs.

Once you hit the $6,350 limit, you pay $3.95 or 5% — whichever is greater — for each generic drug. And you pay $9.85 or 5% — whichever is greater — for each brand name drug.

Last Modified: January 17, 2023

4 Cited Research Articles

  1. U.S. Centers for Medicare & Medicaid Services. (2022, April 29). CY 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F). Retrieved from
  2. U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from
  3. U.S. Centers for Medicare & Medicaid Services. (n.d.). Your Medicare Costs. Retrieved from
  4. U.S. Centers for Medicare & Medicaid Services. (n.d.). 2022 Medicare Costs. Retrieved from