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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 2025, 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 2025.
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 $64.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $400.00 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 $14000.00 (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 $14000.00 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 has a $400 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, the copay is $15 at preferred and mail-order pharmacies, and $20 at standard pharmacies. For preferred brand drugs, you will pay 36% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice Giveback H5216-154 (PPO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services, including preventive care, routine hearing exams, and vision services, often have no copay. The plan includes coverage for primary care, specialist visits, and mental health services, each with specific copays. Additionally, services like ambulance, emergency care, and home health have coverage, and diagnostic and radiological services have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric stays, with a copay of $435 for days 1-5 and no copay for days 6-90 for acute stays, and a copay of $435 for days 1-4 and no copay for days 5-90 for psychiatric stays. Additional days for acute inpatient hospital stays have no copay. Non-Medicare-covered stays and upgrades for acute and psychiatric stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $450, Observation Services with a $435 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse services with copays between $45 and $100 for both individual and group sessions, and Outpatient Blood Services with no copay. Outpatient Services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice Giveback H5216-154 (PPO) plan and requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice Giveback H5216-154 (PPO). Ground and Air Ambulance Services have a copay of $315.00, with no coinsurance. 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 H5216-154 (PPO) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $45 copay, while Worldwide Emergency Services has a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice Giveback H5216-154 (PPO) plan covers primary care physician services with a $20 copay, chiropractic services with a $15 copay (prior authorization required), and occupational therapy services with a $25 copay (prior authorization required). The plan also covers physician specialist services with a $55 copay, mental health specialty services with a $45 copay (for individual and group sessions, prior authorization required), and physical therapy and speech-language pathology services with a $25 copay (prior authorization required). Additional telehealth benefits have a copay between $0 and $55, and opioid treatment program services have a copay between $45 and $100 (prior authorization required).
Preventive Services See details
The HumanaChoice Giveback H5216-154 (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
The HumanaChoice Giveback H5216-154 (PPO) plan covers hearing exams with a $55 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 $699 and $999, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice Giveback H5216-154 (PPO) plan covers vision services, including eye exams with a copay of $0-$55, routine eye exams with no copay, and eyewear with no copay and a combined maximum of $150 per year. The plan covers 1 pair of contact lenses and 1 pair of eyeglasses (lenses and frames) per year with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5216-154 (PPO) plan covers various dental services, including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), and other preventive services with no copay. However, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics, 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 H5216-154 (PPO) plan, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by this plan. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The HumanaChoice Giveback H5216-154 (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $120, and lab services with no copay. Radiological services are covered, with a copay up to $325 for diagnostic services, up to a $55 copay and 20% coinsurance for therapeutic services, and a $20 copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-154 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Giveback H5216-154 (PPO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice Giveback H5216-154 (PPO) plan covers acupuncture with a $55 copay, and a limit of 20 treatments per year, as well as a meal benefit with no copay. Other services, including over-the-counter items, are not covered.
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