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HumanaChoice Giveback H5216-141 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-141 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-141 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-141 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-141 (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 H5216-141 (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 H5216-141 (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 $59.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $1500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $365.00 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 $9400.00 (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 $9400.00 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 H5216-141 (PPO) plan has a $365.00 deductible. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $5.00 copay at a standard pharmacy or preferred mail, or a $20.00 copay at a standard mail pharmacy. For standard generic drugs, the copay is $47.00 regardless of the pharmacy. For preferred brand drugs, you will pay 35% coinsurance. For non-preferred drugs, you will pay 28% coinsurance.
Additional Benefits
The HumanaChoice Giveback H5216-141 (PPO) plan offers a range of benefits, including inpatient hospital care with copays, outpatient services with copays and coinsurance, and coverage for emergency services. This plan also features no copays for primary care visits, routine eye exams, and preventive services such as an annual physical exam, along with coverage for hearing exams and hearing aids with copays. Additional benefits include dental services with no copays for certain services, and home health services with no copay. There is also coverage for ambulance services with copays, and a meal benefit with no copay. The plan also has coverage for various diagnostic services, and offers coverage for medical equipment, including diabetic equipment.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric services. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-6, and no copay for days 7-90, while additional days (91-999) have no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $390 copay for days 1-4, and no copay for days 5-90, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $0-$300 copay and 20% coinsurance, Observation Services with a $320 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $30 copay and 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice Giveback H5216-141 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance Services are covered by the HumanaChoice Giveback H5216-141 (PPO) plan, with a $315 copay for ground ambulance services and a $1250 copay for air ambulance services. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice Giveback H5216-141 (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay. There is no coinsurance for any of these services.
Primary Care See details
The HumanaChoice Giveback H5216-141 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $45 copay, mental health specialty services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a $0-$55 copay, and opioid treatment program services with a $30 copay and 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice Giveback H5216-141 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services have a copay, including services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. This plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
The HumanaChoice Giveback H5216-141 (PPO) plan covers hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $599 and $899, and OTC hearing aids are covered up to $50 every three months. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The HumanaChoice Giveback H5216-141 (PPO) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $45, while routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames) have no copay, with a combined maximum benefit of $250 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5216-141 (PPO) plan covers Medicare dental services with a $45 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HumanaChoice Giveback H5216-141 (PPO) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-141 (PPO) plan. The plan has a coinsurance of 20% for this benefit.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under this plan. Durable Medical Equipment has a 20% coinsurance, while medical supplies have a 20% coinsurance. Diabetic Supplies have between a 10% and 20% coinsurance, with no copay. Diabetic Therapeutic Shoes/Inserts have no copay. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with coinsurance, diagnostic procedures/tests with a copay up to $55 and at least 20% coinsurance, lab services with no copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with at least 20% coinsurance, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-141 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice Giveback H5216-141 (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $45 copay and is limited to 20 treatments per year. OTC items are covered up to $50 every three months, and the meal benefit has no copay. Some services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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