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HumanaChoice Giveback H5216-154 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-154 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-154 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-154 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Georgia and South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-154 (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 H5216-154 (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 H5216-154 (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 $74.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $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 H5216-154 (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order. Tier 2 generic medications are also highly affordable, costing as low as a $5 copay for a one-month supply, or no copay for a three-month supply filled through preferred mail order. For Tier 3 preferred brand drugs, the plan requires a $47 copay for a one-month supply across standard pharmacies and mail order options. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 31% coinsurance and Tier 5 specialty medications requiring a 25% coinsurance.
Additional Benefits
The HumanaChoice Giveback H5216-154 (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copays or coinsurance for primary care visits, preventive screenings, and home health services. For specialist visits, members pay a $45 copay with no coinsurance, while inpatient hospital stays require a $375 daily copay for the first 5 to 7 days and no copay for subsequent days. Outpatient hospital services feature copays ranging from $0 to $450 with no coinsurance, making essential medical care highly accessible. This plan also includes valuable supplemental benefits, such as dental and vision care with no copays or coinsurance for most routine services, plus a $150 annual eyewear allowance. Routine hearing exams are provided with no copay, and prescription hearing aids are covered with copays ranging from $699 to $999. Additionally, emergency care is covered under a $115 copay with no coinsurance, which is waived if you are admitted to the hospital.
Inpatient Hospital See details
HumanaChoice Giveback H5216-154 (PPO) inpatient hospital services are partially covered with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-154 (PPO) covers outpatient services with no coinsurance, featuring a copay ranging from $0 to $450 for outpatient hospital services and $375 per stay for observation services. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
HumanaChoice Giveback H5216-154 (PPO) covers partial hospitalization with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-154 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Giveback H5216-154 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are available for a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-154 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Mental health, psychiatric, and physical therapy services require copays ranging from $25 to $35 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Giveback H5216-154 (PPO) covers annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. However, additional preventive services are not covered, including fitness benefits, health education, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and in-home support.
Hearing Services See details
HumanaChoice Giveback H5216-154 (PPO) covers hearing services, including routine hearing exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams for a $45 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $699 to $999 and no coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice Giveback H5216-154 (PPO) provides partially covered vision services with no deductibles, featuring a $0 to $45 copay and no coinsurance for eye exams, and no copay or coinsurance for covered eyewear up to a $150 annual limit. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, other eye exam services, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5216-154 (PPO) offers partially covered dental services, featuring a $45.00 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive services. Fluoride treatment, orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-154 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice Giveback H5216-154 (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HumanaChoice Giveback H5216-154 (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with a 20% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5216-154 (PPO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $120, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $45 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-154 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice Giveback H5216-154 (PPO) with no coinsurance and require prior authorization, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-154 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day inpatient hospital stay. Beneficiaries pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Giveback H5216-154 (PPO) partially covers other services, offering acupuncture for a $45 copay and no coinsurance for up to 20 treatments per year, alongside a meal benefit with no copay and no coinsurance. Prior authorization is required for these covered services, while over-the-counter (OTC) items are not covered.
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