Plan vs plan · Harris County, TX · 2027 plan year
HumanaChoice H5216-043 (PPO) vs KelseyCare Advantage Signature (HMO)
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
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HumanaChoice H5216-043 (PPO)
- Plan premium
- $0 a month
- Yearly limit, in network
- $6,800
- 2027 star rating
- 4 of 5
- Prior authorization needed for
- 24 services
KelseyCare Advantage Signature (HMO)
- Plan premium
- $0 a month
- Yearly limit, in network
- $4,150
- 2027 star rating
- 4.5 of 5
- Prior authorization needed for
- 19 services
In most states, including Texas, you cannot count on getting Medigap later
You can buy any Medigap plan with no health questions in the 6 months that start when you are 65 or older and have Part B. After that, a Medigap company in Texas can ask about your health. It can say no, or it can charge you more. So if you join a Medicare Advantage plan now, you may not be able to get Medigap later.
One exception is the trial right. If you joined Medicare Advantage when you first got Medicare at 65, or you left a Medigap plan to try Medicare Advantage for the first time, you can switch back within 12 months. Then you can buy a Medigap plan with no health questions.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
Medicare.gov lists $143 to $680 a month for a 65-year-old woman who does not use tobacco. We start at the lowest price. Health questions can raise the price after your first 6 months with Part B.
Original Medicare
With Medigap Plan G at $143 a month and Wellcare Value Script (PDP)
$6,761 a year
- Premiums
- $4,294
- Medical costs
- $292
- Drugs
- $2,175
Most you can pay in a bad year, before drugs: $4,586.
HumanaChoice H5216-043 (PPO)
PPO from Humana
$5,587 a year
- Premiums
- $2,514
- Medical costs
- $1,370
- Drugs
- $1,703
Most you can pay in a bad year, before drugs: $9,314.
KelseyCare Advantage Signature (HMO)
HMO from KelseyCare Advantage
$5,139 a year
- Premiums
- $2,514
- Medical costs
- $975
- Drugs
- $1,650
Most you can pay in a bad year, before drugs: $6,664.
With these settings, KelseyCare Advantage Signature (HMO) costs about $448 less a year than HumanaChoice H5216-043 (PPO).
Tipping point for HumanaChoice H5216-043 (PPO): with this drug use, if your medical copays and coinsurance in this plan pass $2,544 in a year, Original Medicare with Plan G costs less. The plan caps those costs at $6,800.
Tipping point for KelseyCare Advantage Signature (HMO): with this drug use, if your medical copays and coinsurance in this plan pass $2,597 in a year, Original Medicare with Plan G costs less. The plan caps those costs at $4,150.
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: Plan G.
Primary doctor visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice H5216-043 (PPO)
$0
KelseyCare Advantage Signature (HMO)
$0 copay
Specialist visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice H5216-043 (PPO)
$35
Prior authorizationKelseyCare Advantage Signature (HMO)
$20
Lab tests
Original Medicare + Medigap Plan G
$0
most Medicare-covered tests
HumanaChoice H5216-043 (PPO)
$0
Prior authorizationKelseyCare Advantage Signature (HMO)
$0 copay
Prior authorization
MRI or CT scan
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice H5216-043 (PPO)
$0-$360
Prior authorizationKelseyCare Advantage Signature (HMO)
$25-$250
Prior authorization
Emergency room
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice H5216-043 (PPO)
$130
KelseyCare Advantage Signature (HMO)
$150
Urgent care
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice H5216-043 (PPO)
$50
KelseyCare Advantage Signature (HMO)
$25
Outpatient surgery
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice H5216-043 (PPO)
$0
Prior authorizationKelseyCare Advantage Signature (HMO)
$225
Prior authorization
Ground ambulance
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice H5216-043 (PPO)
$325
Prior authorizationKelseyCare Advantage Signature (HMO)
$300
Prior authorization
Hospital stay, 5 days
Original Medicare + Medigap Plan G
$0
Plan G pays the $1,788 Part A deductible
HumanaChoice H5216-043 (PPO)
$1,725
for a 5-day stay
Prior authorizationKelseyCare Advantage Signature (HMO)
$600
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare + Medigap Plan G | HumanaChoice H5216-043 (PPO) | KelseyCare Advantage Signature (HMO) |
|---|---|---|---|
| Monthly premium | Part B $209.50 + Medigap Plan G $143 + drug plan $5.30 | $0 + Part B $209.50 | $0 + Part B $209.50 |
| Yearly limit on what you pay | You pay the $292 Part B deductible. Plan G pays the rest. | $6,800 in network; $10,750 in and out of network | $4,150 in network |
| Medical deductible | $292 Part B. Plan G pays the $1,788 Part A deductible. | $175 | $0 |
| Primary doctor visit | $0, after the $292 yearly Part B deductible | $0 copay | $0 copay |
| Specialist visit | $0, after the $292 yearly Part B deductible | $35 copayPrior authorization | $20 copay |
| Lab tests | $0, most Medicare-covered tests | $0 copayPrior authorization | $0 copayPrior authorization |
| MRI or CT scan | $0, after the $292 yearly Part B deductible | $0-$360 copayPrior authorization | $25-$250 copayPrior authorization |
| X-rays | $0, after the $292 yearly Part B deductible | $0-$145 copayPrior authorization | $0 copayPrior authorization |
| Emergency room | $0, after the $292 yearly Part B deductible | $130 copay | $150 copay |
| Urgent care | $0, after the $292 yearly Part B deductible | $50 copay | $25 copay |
| Outpatient hospital | $0, after the $292 yearly Part B deductible | $0-$400 copayPrior authorization | $350 copayPrior authorization |
| Surgery center | $0, after the $292 yearly Part B deductible | $0 copayPrior authorization | $225 copayPrior authorization |
| Ground ambulance | $0, after the $292 yearly Part B deductible | $325 copayPrior authorization | $300 copayPrior authorization |
| Hospital stay | $0, Plan G pays the $1,788 Part A deductible | $345 per day for days 1-6; $0 per day for days 7-90Prior authorization | $150 per day for days 1-4; $0 per day for days 5-90Prior authorization |
| Skilled nursing facility | $0, Plan G pays days 21-100 | $0 per day for days 1-20; $221 per day for days 21-100Prior authorization | $0 per day for days 1-20; $221 per day for days 21-100Prior authorization |
| Mental health visit | $0, after the $292 yearly Part B deductible | $20 copayPrior authorization | $20 copay |
| Physical therapy | $0, after the $292 yearly Part B deductible | $30 copayPrior authorization | $15-$20 copayPrior authorization |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization | $0 copayPrior authorization |
| Medical equipment | $0, after the $292 yearly Part B deductible | 20% coinsurancePrior authorization | 20% coinsurancePrior authorization |
| Part B drugs | $0 after the $292 Part B deductible | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with Wellcare Value Script (PDP) | $700 | $0 |
| Drug tiers (one month, retail) | Generic: $0 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 49% coinsuranceInjectable Drugs: 15% coinsuranceSpecialty Tier: 25% coinsuranceSelect Care Drugs: $11 copay | Preferred Generic: $0 copayGeneric: $5 copayPreferred Brand: 17% coinsuranceNon-Preferred Drug: 41% coinsuranceSpecialty Tier: 25% coinsurance | Preferred Generic: $0 copayGeneric: $5 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 35% coinsuranceSpecialty Tier: 30% coinsuranceSelect Care Drugs: $0 copay |
Not sure which of these costs apply to you?
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A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In Texas, 10 drug plans are for sale for 2027, from $5.30 to $199 a month. Half of them cost $104.70 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules, and you may not be able to get Medigap later.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
HumanaChoice H5216-043 (PPO)
PPO
- The plan has a network. You can go outside it, but you pay more.
- No referral needed to see a specialist.
Prior authorization for 24 services
Specialist visits, Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Mental health visits, Psychiatrist visits, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Cardiac rehab, Pulmonary rehab, Medical equipment, Prosthetics, Diabetic supplies, Dialysis, Substance use care, Hospital stay, Skilled nursing, Part B drugs
KelseyCare Advantage Signature (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- You need a referral to see a specialist.
Prior authorization for 19 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Surgery center, Ambulance, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Cardiac rehab, Pulmonary rehab, Medical equipment, Prosthetics, Diabetic supplies, Dialysis, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | HumanaChoice H5216-043 (PPO) | KelseyCare Advantage Signature (HMO) |
|---|---|---|---|
| Dental | No | Comprehensive, up to $2,000 a year | Comprehensive, up to $2,500 a year |
| Eye exam | No | Yes | Yes |
| Glasses or contacts | No | Yes, $150 allowance | Yes, $125 allowance |
| Hearing aids | No | Yes, copays from $575 | Yes, up to $750 |
| Over-the-counter allowance | No | $200 a year | $100 a year |
| Fitness benefit | No | Yes | Yes |
| Rides to care | No | No | Yes |
| Meals after a hospital stay | No | Yes | No |
| Emergency care abroad | Plan G and Plan N pay 80% after a $250 deductible | Yes | Yes |
| Part B premium giveback | No | No | No |
What changed for 2027
HumanaChoice H5216-043 (PPO)
Renewal Plan · 2026 plan H5216-043-6
- Medical deductible up from $0 to $175
- Drug deductible up from $420 to $700
- Part B giveback down from $2 to $0
- Specialist visit: $30 copay to $35 copay
- Emergency care: $115 copay to $130 copay
- Urgent care: $40 copay to $50 copay
- Outpatient hospital: $0-$300 copay to $0-$400 copay
- Ground ambulance: $335 copay to $325 copay
- Inpatient hospital: $340 per day for days 1-6; $0 per day for days 7-90 to $345 per day for days 1-6; $0 per day for days 7-90
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-100 to $0 per day for days 1-20; $221 per day for days 21-100
- Yearly OTC allowance up from $160 to $200
- Overall star rating up from 3.5 to 4
KelseyCare Advantage Signature (HMO)
Renewal Plan · 2026 plan H0332-009-0
- In-network out-of-pocket maximum up from $3,900 to $4,150
- Emergency care: $125 copay to $150 copay
- Diagnostic radiology (MRI, CT): $25-$200 copay to $25-$250 copay
- Outpatient hospital: $300 copay to $350 copay
- Ground ambulance: $275 copay to $300 copay
- Skilled nursing facility: $0 per day for days 1-20; $218 per day for days 21-100 to $0 per day for days 1-20; $221 per day for days 21-100
More 2027 plans in Harris County
- HealthSpring Preferred (HMO), H4513-061
- HealthSpring Preferred Savings (HMO), H4513-083
- Humana Essentials Plus Giveback (PPO), H7617-035
- AARP Medicare Advantage from UHC TX-0015 (HMO-POS), H4527-037
- HealthSpring Preferred Extra Savings (HMO), H4513-091
- HumanaChoice Giveback H5216-358 (PPO)
- Humana USAA Honor Giveback (PPO), H5216-348
- Wellcare TexanPlus Classic Simple (HMO-POS), H4506-003
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Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. Medigap prices are the range Medicare.gov showed for ZIP 77002 on 2026-10-09. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- HumanaChoice H5216-043 (PPO) on Medicare.gov · plan website · drug list · doctor directory
- KelseyCare Advantage Signature (HMO) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices for ZIP 77002 on Medicare.gov
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.