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Original Medicare vs a plan · Milwaukee County, WI · 2027 plan year

Original Medicare vs Humana Value Plus H5216-173 (PPO)

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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Humana Value Plus H5216-173 (PPO)

Plan premium
$6.30 a month
Yearly limit, in network
$9,850
2027 star rating
4 of 5
Prior authorization needed for
24 services

In most states, including Wisconsin, 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 Wisconsin 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.gov

Your yearly cost, side by side

Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.

How much care do you expect?

Ongoing specialist care

Medigap plan with Original Medicare

Wisconsin sets its own Medigap plans: a basic plan with optional riders, two cost-sharing plans, and a high-deductible plan. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices for these plans, so the totals show Original Medicare without Medigap. Without Medigap you pay 20% of most costs, with no yearly limit. Check Medigap plans and prices for ZIP 53132 on Medicare.gov

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

Original Medicare

With no Medigap and AARP Medicare Rx Saver from UHC (PDP)

$6,133 a year

Premiums
$2,638
Medical costs
$1,616
Drugs
$1,880

No yearly limit on what you pay for medical care.

Humana Value Plus H5216-173 (PPO)

PPO from Humana

$4,013 a year

Premiums
$2,590
Medical costs
$1,423
Drugs
$0

Most you can pay in a bad year, before drugs: $12,440.

With these settings, Humana Value Plus H5216-173 (PPO) costs about $2,121 less a year than Original Medicare.

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.

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What 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: no Medigap.

Primary doctor visit

  • Original Medicare, no Medigap

    20%

    after the $292 yearly Part B deductible

  • Humana Value Plus H5216-173 (PPO)

    $0

Specialist visit

  • Original Medicare, no Medigap

    20%

    after the $292 yearly Part B deductible

  • Humana Value Plus H5216-173 (PPO)

    20%

    Prior authorization

Lab tests

  • Original Medicare, no Medigap

    $0

    most Medicare-covered tests

  • Humana Value Plus H5216-173 (PPO)

    $0

    Prior authorization

MRI or CT scan

  • Original Medicare, no Medigap

    20%

    after the $292 yearly Part B deductible

  • Humana Value Plus H5216-173 (PPO)

    $0-$345 or 20%

    Prior authorization

Emergency room

  • Original Medicare, no Medigap

    20%

    after the $292 yearly Part B deductible

  • Humana Value Plus H5216-173 (PPO)

    $115

Urgent care

  • Original Medicare, no Medigap

    20%

    after the $292 yearly Part B deductible

  • Humana Value Plus H5216-173 (PPO)

    30%

Outpatient surgery

  • Original Medicare, no Medigap

    20%

    after the $292 yearly Part B deductible

  • Humana Value Plus H5216-173 (PPO)

    $0 or 20%

    Prior authorization

Ground ambulance

  • Original Medicare, no Medigap

    20%

    after the $292 yearly Part B deductible

  • Humana Value Plus H5216-173 (PPO)

    $325

    Prior authorization

Hospital stay, 5 days

  • Original Medicare, no Medigap

    $1,788

    Part A deductible each benefit period; $447 a day for days 61-90

  • Humana Value Plus H5216-173 (PPO)

    $1,545

    for a 5-day stay

    Prior authorization
See every cost in one table
What you pay in networkOriginal Medicare, no MedigapHumana Value Plus H5216-173 (PPO)
Monthly premiumPart B $209.50 + drug plan $10.30$6.30 + Part B $209.50
Yearly limit on what you payNo yearly limit$9,850 in network; $14,800 in and out of network
Medical deductible$292 Part B; $1,788 Part A each benefit period$0
Primary doctor visit20%, after the $292 yearly Part B deductible$0 copay
Specialist visit20%, after the $292 yearly Part B deductible20% coinsurancePrior authorization
Lab tests$0, most Medicare-covered tests$0 copayPrior authorization
MRI or CT scan20%, after the $292 yearly Part B deductible$0-$345 copay, 20% coinsurancePrior authorization
X-rays20%, after the $292 yearly Part B deductible$0-$40 copay, 20%-30% coinsurancePrior authorization
Emergency room20%, after the $292 yearly Part B deductible$115 copay
Urgent care20%, after the $292 yearly Part B deductible30% coinsurance
Outpatient hospital20%, after the $292 yearly Part B deductible$0-$35 copay, 20% coinsurancePrior authorization
Surgery center20%, after the $292 yearly Part B deductible$0 copay, 20% coinsurancePrior authorization
Ground ambulance20%, after the $292 yearly Part B deductible$325 copayPrior authorization
Hospital stay$1,788, Part A deductible each benefit period; $447 a day for days 61-90$1,545 per stayPrior authorization
Skilled nursing facility$0, days 1-20, then $223.50 a day for days 21-100$0 per day for days 1-20; $221 per day for days 21-100Prior authorization
Mental health visit20%, after the $292 yearly Part B deductible$35 copayPrior authorization
Physical therapy20%, after the $292 yearly Part B deductible20% coinsurancePrior authorization
Home health care$0, Medicare-covered home health$0 copayPrior authorization
Medical equipment20%, after the $292 yearly Part B deductible16% coinsurancePrior authorization
Part B drugs20% after the $292 Part B deductible$0 copay, 0%-20% coinsurancePrior authorization
Drug deductible (Part D)$700 with AARP Medicare Rx Saver from UHC (PDP)$700
Drug tiers (one month, retail)Preferred Generic: $0 copayGeneric: $5 copayPreferred Brand: 20% coinsuranceNon-Preferred Drug: 31% coinsuranceSpecialty Tier: 25% coinsuranceNo drug coverage

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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 Wisconsin, 8 drug plans are for sale for 2027, from $5.30 to $189.10 a month. Half of them cost $10.85 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

Humana Value Plus H5216-173 (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

Extra benefits

Extra benefitOriginal MedicareHumana Value Plus H5216-173 (PPO)
DentalNoComprehensive, up to $3,500 a year
Eye examNoYes
Glasses or contactsNoYes, $200 allowance
Hearing aidsNoYes, copays from $0
Over-the-counter allowanceNo$220 a year
Fitness benefitNoYes
Rides to careNoNo
Meals after a hospital stayNoYes
Emergency care abroadNo, unless your Medigap plan pays for itYes
Part B premium givebackNoNo

What changed for 2027

Humana Value Plus H5216-173 (PPO)

Renewal Plan · 2026 plan H5216-173-0

  • Monthly premium down from $21 to $6
  • In-network out-of-pocket maximum up from $9,250 to $9,850
  • Drug deductible up from $615 to $700
  • Part B giveback down from $1 to $0
  • Diagnostic radiology (MRI, CT): $0-$335 copay, 20% coinsurance to $0-$345 copay, 20% coinsurance
  • Outpatient hospital: $0 copay, 20% coinsurance to $0-$35 copay, 20% coinsurance
  • Ground ambulance: $335 copay to $325 copay
  • Inpatient hospital: $1,882 per stay to $1,545 per stay
  • 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
  • Dental maximum down from $5,000 to $3,500
  • Yearly OTC allowance down from $500 to $220
  • Eyewear allowance down from $350 to $200
  • Overall star rating up from 3.5 to 4

More 2027 plans in Milwaukee County

County guide: 2027 plans in Milwaukee CountyState guide: Wisconsin

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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. Wisconsin sets its own Medigap plans: a basic plan with optional riders, two cost-sharing plans, and a high-deductible plan. These plans are not the plans with letters, such as Plan G and Plan N. We have no prices or cost model for these plans, so the totals show Original Medicare without Medigap. You can look up Medigap plans and prices for ZIP 53132 on Medicare.gov. Totals use typical Medicare-allowed amounts for each service and typical drug prices.

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.

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