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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 2026, 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 2026.
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 $86.00. 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 $615.00 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 $8900.00 (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 $8900.00 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 an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies, and you will pay no copay for a 3-month supply filled through preferred mail order. For Tier 3 preferred brand drugs, the plan charges a $47 copay for a 1-month supply at standard pharmacies or mail order, though a 3-month preferred mail order supply costs $94. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 37% coinsurance and Tier 5 specialty medications requiring a 25% coinsurance. This structure helps beneficiaries estimate their out-of-pocket prescription costs throughout the year.
Additional Benefits
The HumanaChoice Giveback H5216-141 (PPO) plan offers affordable coverage with no copays for primary care visits, home health services, and routine preventive care. For specialist visits, patients pay a $45 copay, while inpatient hospital stays require a $320 daily copay for the first six days of acute stays. Emergency room visits carry a $130 copay, and outpatient hospital services range from no copay up to a $320 copay. This plan also includes key dental, vision, and hearing benefits, featuring no copays for routine eye exams, select eyewear up to a $250 annual limit, and most preventive dental care up to a $1,000 limit. Routine hearing exams and over-the-counter hearing aids are covered with no copay, while prescription hearing aids require copays between $699 and $999. For durable medical equipment and dialysis services, members will pay a 20% coinsurance with no copay.
Inpatient Hospital See details
HumanaChoice Giveback H5216-141 (PPO) covers inpatient hospital services with no coinsurance, featuring a $320 daily copay for days 1 to 6 of acute stays and a $390 daily copay for days 1 to 4 of psychiatric stays, with no copays 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
HumanaChoice Giveback H5216-141 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $320 copay for outpatient hospital services and a $25 to $35 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for most services.
Partial Hospitalization See details
HumanaChoice Giveback H5216-141 (PPO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice Giveback H5216-141 (PPO) with no coinsurance, requiring a $335 copay for ground ambulance and a $1,250 copay for air ambulance. Under transportation services, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
HumanaChoice Giveback H5216-141 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-141 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, speech, and mental health therapies are covered with a $25 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by the HumanaChoice Giveback H5216-141 (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs. Additional preventive benefits are partially covered, offering a memory fitness benefit with no copay and no coinsurance, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by HumanaChoice Giveback H5216-141 (PPO) with no coinsurance, offering Medicare-covered exams for a $45 copay, alongside one annual routine exam and unlimited fitting evaluations with no copay. Prescription hearing aids are partially covered with a copay between $699 and $999 for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice Giveback H5216-141 (PPO) vision services are partially covered, featuring no deductibles, no coinsurance, and no copays for one routine eye exam and select eyewear like contact lenses or eyeglasses (lenses and frames) up to a $250 annual limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services under HumanaChoice Giveback H5216-141 (PPO) are partially covered up to a $1,000 annual limit, with no copay and no coinsurance for most diagnostic, preventive, and comprehensive care. However, Medicare-covered dental requires a $45 copay with no coinsurance, prosthodontics require a 30% coinsurance with no copay, and fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-141 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, insulin, and other drugs carry a 0% to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by the HumanaChoice Giveback H5216-141 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
HumanaChoice Giveback H5216-141 (PPO) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay, requiring prior authorization. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay from specified manufacturers, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5216-141 (PPO) covers diagnostic and radiological services, with prior authorization required. Lab services, outpatient X-rays, and diagnostic radiological services feature no copay, while diagnostic procedures and therapeutic radiological services incur up to 20% coinsurance and copays ranging from $0 to $50.
Home Health Services See details
HumanaChoice Giveback H5216-141 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
HumanaChoice Giveback H5216-141 (PPO) does not cover Cardiac Rehabilitation Services in practice, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered. While the plan technically lists no coinsurance, no copayments are applicable since these services are excluded from coverage.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-141 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services covered by HumanaChoice Giveback H5216-141 (PPO) include acupuncture, over-the-counter (OTC) items, and meal benefits for chronic illnesses. Acupuncture has a $45 copay and no coinsurance for up to 20 treatments per year, while OTC items and qualifying meal benefits are offered with no copay and no coinsurance.
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