HumanaChoice H5216-249 (PPO) 2026 Plan Details for Suffolk County, Massachusetts Residents
HumanaChoice H5216-249 (PPO) 2026 Plan Details for Suffolk County, Massachusetts Residents
Navigating your Medicare Advantage options in Suffolk County for 2026 can be overwhelming, but we're here to help. With HumanaChoice H5216-249 (PPO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
The latest CMS enrollment data shows an estimated 1,739 Medicare beneficiaries are enrolled in this plan, with 321 members in Suffolk County, MA.
HumanaChoice H5216-249 Overview
| Plan ID H5216-249-0 Overview | |
|---|---|
| Health Plan ID: | H5216-249-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $6750.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $350.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Suffolk County, MA |
| Insured By: | Humana |
Explore the Benefits of HumanaChoice H5216-249
This MAPD PPO Medicare Advantage plan offers broad coverage with the freedom to choose your providers. With a monthly premium of $0.00, it includes all core benefits under Medicare Part A and Part B, plus prescription drug coverage to manage ongoing medications. The annual Part D deductible is $350.00. You can see any Medicare-approved provider — in or out of network — though in-network care typically costs less.
Primary care visits have a $0 copay | Out-of-network: $10 copay, and specialist visits come with a $30 copay | Out-of-network: $50 copay. Urgent care services carry a $50 copay, and ground ambulance transportation is $335 copay | Out-of-network: $335 copay. These costs all count toward your annual maximum out-of-pocket (MOOP) limit of $6750.00. After that limit is reached, all in-network care is fully covered through the end of the year.
CMS recognizes this plan as H5216-249-0. A detailed breakdown of cost sharing is available below. Still have questions? Check the FAQ section for more insights.
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Out-of-Pocket Costs
With HumanaChoice H5216-249, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H5216-249-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $10 copay |
| Specialist: | In-network: $30 copay | Out-of-network: $50 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$50 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: $0 copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $130 copay |
| Wordwide emergency care: | $130 copay |
| Urgent care: | $50 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $350 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | $395 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $10 per day for days 1-20 | $218 per day for days 21-100 | Out-of-network: | 30% per stay |
| Ground ambulance: | In-network: $335 copay | Out-of-network: $335 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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 | $350 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | $395 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $15 copay | Out-of-network: 30% coinsurance |
| Occupational therapy: | In-network: $15 copay | Out-of-network: 30% coinsurance |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay, 10%-20% coinsurance | Out-of-network: 20% coinsurance |
| Durable medical equipment: | In-network: $0 copay, 20% coinsurance | Out-of-network: 30% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 30% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0-$780 copay | Out-of-network: $0 copay, 30% coinsurance |
| Lab services: | In-network: $0-$50 copay | Out-of-network: $10-$50 copay, 30% coinsurance |
| Outpatient x-rays: | In-network: $0-$125 copay | Out-of-network: $10-$50 copay, 30% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$90 copay | Out-of-network: $10-$50 copay, 30%-50% coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 30% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 30% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| 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, 30%-40% coinsurance | Out-of-network: $0 copay, 30%-40% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $0 copay |
| Prescription hearing aids: | In-network: $0-$299 copay | Out-of-network: $0-$299 copay |
| OTC hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| 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 |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by HumanaChoice H5216-249 as a Part B benefit.
Part D Prescription Drug Costs & Benefits
HumanaChoice H5216-249 includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $-30.50 |
|---|---|
| Supplemental Part D Premium: | $30.50 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $35.76 |
| 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 $350.00 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 H5216-249 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 | $1.00 copay | Coming soon |
| Preferred Brand | $44.00 copay | Coming soon |
| Non-Preferred Drug | 43% coinsurance | Coming soon |
| Specialty Tier | 29% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Am I Eligible for HumanaChoice H5216-249?
To enroll in HumanaChoice H5216-249, you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
If you meet these requirements, you are eligible to enroll in HumanaChoice H5216-249 and benefit from its comprehensive coverage options.
When Can I Enroll in HumanaChoice H5216-249?
To ensure you don’t miss your chance to enroll in HumanaChoice H5216-249, be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to get assistance from a licensed insurance agent.
How to Sign Up for HumanaChoice H5216-249
Joining HumanaChoice H5216-249 is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join HumanaChoice H5216-249.
- Direct Enrollment: You can also choose to enroll directly with HumanaChoice H5216-249. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Here are some of the most frequently asked questions people have about plan ID H5216-249-0:
Is there a premium for this plan in 2026?
Members pay their Part B premium and the plan's of $0.00 per month to be in this 2026 plan.
How high can my costs go in a worst-case year?
The annual in-network MOOP is $6750.00, protecting you from larger bills once you hit that limit.
Is there a Part D deductible with this plan?
The 2026 drug deductible is $350.00.
Is this a 4-star or 5-star plan?
The latest CMS score is ★3.5 out of 5 stars; anything 4 or higher earns quality bonuses.
Is HumanaChoice H5216-249 popular?
Enrollment stands at roughly 1,739 members.
Contact 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 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Humana, http://www.humana.com/medicare — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- Medicare.gov, "Joining a plan" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
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Page content managed by David Bynon, Medicare Analyst.
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