A non-government entity
HumanaChoice Giveback H5216-116 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-116 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-116 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-116 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Pennsylvania and New Jersey. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-116 (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice Giveback H5216-116 (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 H5216-116 (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 $60.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6200.00 (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 $6200.00 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:
Sign up for HumanaChoice Giveback H5216-116 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by HumanaChoice Giveback H5216-116 (PPO).
Additional Benefits
The HumanaChoice Giveback H5216-116 (PPO) plan provides comprehensive medical coverage with no copay for primary care visits and a $25 copay for specialists. If you require hospital care, acute inpatient stays require a $495 copay for days 1 to 6, while emergency room visits have a $150 copay. Outpatient services and laboratory tests are also covered, often requiring no copay and no coinsurance. Beyond standard medical care, this plan includes valuable dental, vision, and hearing benefits, featuring no copay for preventive dental services up to $1,000 annually and routine eye exams. Members also benefit from no copay for home health services, over-the-counter items, and up to 24 one-way transportation trips. Specialized services like dialysis and durable medical equipment are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice Giveback H5216-116 (PPO) covers inpatient hospital services with no coinsurance, requiring a $495 copay for days 1 to 6 of an acute stay and a $450 copay for days 1 to 5 of a psychiatric stay, with no copay for remaining covered days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice Giveback H5216-116 (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $800, observation services require a $495 copay per stay, and outpatient substance abuse sessions have a $25 to $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by the HumanaChoice Giveback H5216-116 (PPO) plan with a $35.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice Giveback H5216-116 (PPO), featuring a $335 copay and no coinsurance for ground and air ambulance rides. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
HumanaChoice Giveback H5216-116 (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $60 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-116 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Therapy and mental health services require copays ranging from $10 to $25 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
HumanaChoice Giveback H5216-116 (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physicals, kidney disease education, and screenings for glaucoma, diabetes, and EKGs. While memory fitness and chemotherapy-related wigs (up to $500 annually) are covered with no copay and no coinsurance, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, or counseling.
Hearing Services See details
HumanaChoice Giveback H5216-116 (PPO) covers hearing services, including routine exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams with a $25 copay and no coinsurance. Prescription hearing aids are partially covered with a $499 to $799 copay and no coinsurance, excluding inner ear, outer ear, and over-the-ear models, while over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice Giveback H5216-116 (PPO) partially covers vision services with no coinsurance, featuring eye exams with a $0 to $25 copay and eyewear with no copay, up to annual benefit limits. While routine exams, contact lenses, and eyeglasses are covered, other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice Giveback H5216-116 (PPO), offering up to a $1,000 annual maximum benefit with no copay and no coinsurance for preventive care like cleanings and exams. Medicare-covered and restorative services require a $25 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-116 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, insulin, and other infusion drugs carry a 0% to 20% coinsurance, with insulin drugs also featuring a $35 copay.
Dialysis Services See details
HumanaChoice Giveback H5216-116 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice Giveback H5216-116 (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5216-116 (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures have no coinsurance and a copay of $0 to $95, lab services have no copay or coinsurance, and radiological services range from outpatient X-rays with no copay to therapeutic services requiring a minimum 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice Giveback H5216-116 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HumanaChoice Giveback H5216-116 (PPO) plan with no coinsurance and require prior authorization, though only some services are covered in practice. Intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered, and other covered rehabilitation services require copayments ranging from $10 to $25.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice Giveback H5216-116 (PPO) with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a three-day prior hospital stay is not necessary for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services covered by HumanaChoice Giveback H5216-116 (PPO) include acupuncture for a $25 copay and no coinsurance, alongside over-the-counter items and chronic illness meals for no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while certain other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved