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HumanaChoice Giveback H5216-017 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-017 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-017 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-017 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-017 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice Giveback H5216-017 (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HumanaChoice Giveback H5216-017 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $94.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $450.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HumanaChoice Giveback H5216-017 (PPO) plan features an annual drug deductible of $450 before coverage begins. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications are available for a $5 copay for a one-month supply, or no copay for a three-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, while a three-month supply through preferred mail order costs $131. For higher-tier medications, you will pay a 41% coinsurance for Tier 4 non-preferred drugs and a 27% coinsurance for Tier 5 specialty drugs. These clear copay and coinsurance structures help you easily estimate your annual out-of-pocket prescription expenses with this Medicare Advantage plan.
Additional Benefits
The HumanaChoice Giveback H5216-017 (PPO) plan offers medical coverage featuring no copay and no coinsurance for primary care provider visits, annual physical exams, and home health services. Specialist visits require a $40 copay, and emergency room visits carry a $115 copay which is waived if you are admitted within 24 hours. For inpatient hospital stays, there is no coinsurance, but patients pay a $375 daily copay for the first several days before transitioning to no copay. Routine vision exams, eyewear, and preventive dental care are also available with no copay, while diagnostic lab tests and home infusion services are covered with no copay. However, certain services like dialysis and durable medical equipment require a 20% coinsurance, and prescription hearing aids have copays between $699 and $999. It is important to note that this plan does not cover routine transportation, over-the-counter items, or fitness benefits.
Inpatient Hospital See details
Inpatient hospital services are covered by HumanaChoice Giveback H5216-017 (PPO) with no coinsurance, requiring a $375 daily copay for days 1 to 7 for acute stays and days 1 to 5 for psychiatric stays, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-017 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions have a $35 copay and no coinsurance.
Partial Hospitalization See details
HumanaChoice Giveback H5216-017 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-017 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Giveback H5216-017 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-017 (PPO) primary care benefits are partially covered, featuring no copay and no coinsurance for primary care provider visits, and a $40 copay with no coinsurance for specialists. Physical, occupational, and speech therapies require a $25 copay with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by HumanaChoice Giveback H5216-017 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings. However, additional preventive services—including fitness benefits, health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, weight management, alternative therapies, and caregiver support—are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice Giveback H5216-017 (PPO), offering Medicare-covered exams for a $40 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $699 and $999 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H5216-017 (PPO) partially covers vision services with no coinsurance and no deductibles, offering a $0 to $40 copay for eye exams and no copay for eyewear. Covered benefits include one routine eye exam and a $150 annual allowance for contact lenses or eyeglasses, while other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice Giveback H5216-017 (PPO), featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-017 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice Giveback H5216-017 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice Giveback H5216-017 (PPO), including durable medical equipment and prosthetics which require a 20% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and 10% to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the HumanaChoice Giveback H5216-017 (PPO) plan, with prior authorization required for most services. Diagnostic services feature no coinsurance, with lab services requiring no copay and other diagnostic tests carrying a copay of $0 to $120. For radiological services, outpatient X-rays require coinsurance but no copay, diagnostic radiological services start at no copay, and therapeutic services carry a $40 copay and 20% coinsurance.
Home Health Services See details
The HumanaChoice Giveback H5216-017 (PPO) plan covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under HumanaChoice Giveback H5216-017 (PPO), but only some services are covered in practice. Specifically, standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-017 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Giveback H5216-017 (PPO) covers select other services, including acupuncture for a $40 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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