HumanaChoice H5216-042 (PPO)

Available to residents of Shelby County, TX for 2026. Contract H5216, plan 042, segment 0.

Renewed for 2026. CMS carries this plan forward from 2025.

Plan details

Monthly premium (Part C + D)	$60.00
— medical (Part C) part	$0.00
— drug (Part D) part	$60.00?
Monthly premium with full Extra Help (LIS)	$55.20?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$6,750.00?
In- and out-of-network out-of-pocket maximum	$9,000.00
Drug deductible	$615.00Tier 1, 2 and 3 exempt
Drug out-of-pocket threshold	$2,100.00
Plan type	PPO?
Contract / plan	H5216-042-0
Offered by	Humana
Parent organization	Humana Inc.
Formulary drugs	3,359
Formulary exception tier	4?
Pharmacy search	www.humana.com/pharmacy/
Member services	(888)873-0686TTY 711

CMS star ratings

Overall: 3.5 out of 5 stars for Overall
Health plan (Part C): 3.5 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 3 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H5216 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	$0 copay	50% coinsurance
Specialist	$35 copay(authorization required)	50% coinsurance
Other health care professional	$0–$35 copay(authorization required)	50% coinsurance
Additional telehealth services	$0–$50 copay	—
Preventive care
Medicare-covered preventive services	$0 copay	$0 copay; 50% coinsurance
Annual physical exam	$0 copay	50% coinsurance
Kidney disease education	$0 copay	50% coinsurance
Glaucoma screening	$0 copay	50% coinsurance
Diabetes self-management training	$0 copay	50% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	$0–$100 copay(authorization required)	50% coinsurance
Lab services	$0–$50 copay(authorization required)	50% coinsurance
Diagnostic radiology (e.g. MRI, CT)	$0–$360 copay(authorization required)	$0 copay; 50% coinsurance
Therapeutic radiology	$40 copay; 20% coinsurance(authorization required)	50% coinsurance
Outpatient x-rays	$0–$130 copay(authorization required)	50% coinsurance
Emergency and urgent care
Emergency room	$130 copay	—
Urgent care	$50 copay	—
Worldwide emergency coverage	$130 copay	—
Worldwide urgent care	$130 copay	—
Worldwide emergency transportation	$130 copay	—
Hospital care
Inpatient hospital stay	$325 per day for days 1–5; $0 per day for days 6–90; $0 per day for days 91–999 (additional days)(authorization required)	50% coinsurance per stay
Outpatient hospital services	$0–$350 copay(authorization required)	$0 copay; 50% coinsurance
Outpatient observation	$325 copay(authorization required)	$325 copay
Ambulatory surgical center	$0–$275 copay(authorization required)	$0 copay; 50% coinsurance
Outpatient blood services	$0 copay(authorization required)	$0 copay
Skilled nursing and home health
Skilled nursing facility	$10 per day for days 1–20; $218 per day for days 21–100(authorization required)	50% coinsurance per stay
Home health care	$0 copay(authorization required)	50% coinsurance
Kidney dialysis	20% coinsurance(authorization required)	20% coinsurance
Rehabilitation
Occupational therapy	$25 copay(authorization required)	50% coinsurance
Physical therapy and speech-language therapy	$25 copay(authorization required)	50% coinsurance
Cardiac rehabilitation	$20 copay(authorization required)	50% coinsurance
Pulmonary rehabilitation	$15 copay(authorization required)	50% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$325 per day for days 1–5; $0 per day for days 6–90(authorization required)	50% coinsurance per stay
Outpatient mental health, individual session	$30 copay(authorization required)	50% coinsurance
Outpatient mental health, group session	$30 copay(authorization required)	50% coinsurance
Psychiatrist, individual session	$30 copay(authorization required)	50% coinsurance
Psychiatrist, group session	$30 copay(authorization required)	50% coinsurance
Partial hospitalization	$35 copay(authorization required)	50% coinsurance
Intensive outpatient program	$35 copay(authorization required)	50% coinsurance
Outpatient substance use, individual session	$30–$35 copay(authorization required)	50% coinsurance
Outpatient substance use, group session	$30–$35 copay(authorization required)	50% coinsurance
Opioid treatment program	$30–$35 copay(authorization required)	50% coinsurance
Ambulance and transportation
Ground ambulance	$335 copay(authorization required)	$335 copay
Air ambulance	20% coinsurance(authorization required)	20% coinsurance
Transportation to plan-approved locations	Not covered	—
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	$0 copay; 20% coinsurance(authorization required)	50% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	50% coinsurance
Medical supplies	20% coinsurance(authorization required)	50% coinsurance
Diabetes supplies	$0 copay; 10%–20% coinsurance(authorization required)	50% coinsurance
Diabetic therapeutic shoes or inserts	$10 copay(authorization required)	50% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$15 copay(authorization required)	50% coinsurance
Routine chiropractic care	Not covered	—
Acupuncture	$35 copay(authorization required, limits apply)	$35 copay
Foot exams and treatment (Medicare-covered)	$35 copay(authorization required)	50% coinsurance
Routine foot care	Not covered	—
Dental?
Medicare-covered dental services	$35 copay(authorization required)	50% coinsurance
Preventive dental plan limit	$1,500 plan limit every year	—
Oral exams	$0 copay(limits apply)	$0 copay
Cleanings	$0 copay(limits apply)	$0 copay
Fluoride treatment	Not covered	—
Dental x-rays	$0 copay(limits apply)	$0 copay
Other diagnostic dental services	$0 copay(limits apply)	$0 copay
Other preventive dental services	$0 copay(limits apply)	$0 copay
Restorative services (fillings, crowns)	$0 copay(authorization required, limits apply)	$0 copay; 30%–40% coinsurance
Endodontics (root canals)	$0 copay(authorization required, limits apply)	$0 copay
Periodontics (gum disease)	$0 copay(authorization required, limits apply)	$0 copay
Dentures and other removable prosthodontics	$0 copay; 30% coinsurance(authorization required, limits apply)	$0 copay; 30% coinsurance
Maxillofacial prosthetics	Not covered	—
Implants	Not covered	—
Bridges and other fixed prosthodontics	Not covered	—
Oral and maxillofacial surgery	$0 copay(authorization required, limits apply)	$0 copay
Orthodontics	Not covered	—
Adjunctive general services	$0 copay(authorization required, limits apply)	$0 copay
Vision?
Eye exam (Medicare-covered)	$0–$35 copay(authorization required, limits apply)	50% coinsurance
Routine eye exam	$0 copay(authorization required, limits apply)	$0 copay
Eyewear after cataract surgery (Medicare-covered)	$0 copay(authorization required, limits apply)	$0 copay
Eyewear plan limit	$250 plan limit every year	—
Contact lenses	$0 copay(authorization required, limits apply)	$0 copay
Eyeglasses (frames and lenses)	$0 copay(authorization required, limits apply)	$0 copay
Eyeglass lenses	Not covered	—
Eyeglass frames	Not covered	—
Eyewear upgrades	Not covered	—
Hearing?
Hearing exam (Medicare-covered)	$35 copay(authorization required)	50% coinsurance
Routine hearing exam	$0 copay(authorization required, limits apply)	$0 copay
Hearing aid fitting and evaluation	$0 copay(authorization required)	$0 copay
Hearing aids (all types)	$0–$599 copay(limits apply)	$0–$599 copay
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	0%–20% coinsurance(authorization required, step therapy may apply)	50% coinsurance
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)	50% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)	50% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	Not covered	—
Meals after a hospital stay or for a chronic condition	$0 copay(authorization required)	$0 copay
Fitness benefit	$0 copay	$0 copay
Health education	Not covered	—
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	Not covered	—
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	Not covered	—
Home and bathroom safety devices	Not covered	—
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	Not covered	—
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	Not covered	—
Weight management programs	Not covered	—
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	Not covered	—
Support for caregivers	Not covered	—

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1	$0.00
Tier 2	$10.00
Tier 3	$47.00
Tier 4	48%
Tier 5	25%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial deductible phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$10.00	$10.00	$10.00	$30.00	$30.00	$0.00
Tier 3: Preferred Brand	$47.00	$47.00	$47.00	$141.00	$141.00	$131.00
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$10.00	$10.00	$10.00	$30.00	$30.00	$0.00
Tier 3: Preferred Brand	$47.00	$47.00	$47.00	$141.00	$141.00	$131.00
Tier 4: Non-Preferred Drug	48%	48%	48%	48%	48%	48%
Tier 5: Specialty Tier	25%	25%	25%	n/a	n/a	n/a
Catastrophic coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 3: Preferred Brand	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 4: Non-Preferred Drug	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 5: Specialty Tier	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00

Benefits in plain text

HumanaChoice H5216-042 (PPO) (H5216-042-0) is a 2026 PPO Medicare Advantage plan offered by Humana, available to residents of Shelby County, TX.

The monthly premium is $60.00 (Part C and Part D together).

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $55.20.

Its in-network out-of-pocket maximum is $6,750.00.

The combined in- and out-of-network out-of-pocket maximum is $9,000.00.

The drug deductible is $615.00. Tier 1, 2 and 3 exempt.

The plan's formulary lists 3,359 drugs.

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $10.00; tier 3: $47.00; tier 4: 48%; tier 5: 25%.

CMS gives the plan's contract (H5216) an overall rating of 3.5 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.