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HumanaChoice Giveback H5216-194 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-194 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-194 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-194 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Northern Nevada Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-194 (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 H5216-194 (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 H5216-194 (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 $75.00. 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 $10100.00 (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 $10100.00 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 H5216-194 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $8 for a 1-month supply at standard pharmacies and preferred mail order, but you will pay no copay for a 3-month supply filled through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply across standard pharmacies, preferred mail order, and standard mail order. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs requiring 47% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require 25% coinsurance for a 1-month supply at standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The HumanaChoice Giveback H5216-194 (PPO) plan offers affordable access to essential medical services, featuring no copay and no coinsurance for primary care visits, telehealth, and routine preventive care. For specialist visits, members pay a $65 copay, while inpatient hospital stays require a $450 daily copay for the first five days and no copay for days six through ninety. Emergency room visits carry a $130 copay with no coinsurance, which is waived if you are admitted to the hospital within 24 hours. This plan also includes key supplemental benefits, such as routine dental care, annual eye exams, and routine hearing exams, all with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999, and dental services have a $1,500 annual maximum benefit. Additionally, home health services and home infusion bundled services are covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Inpatient Hospital See details
HumanaChoice Giveback H5216-194 (PPO) inpatient hospital care is partially covered with no coinsurance, requiring a $450 daily copay for days 1 through 5 and no copay for days 6 through 90. While acute stays offer unlimited additional days with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice Giveback H5216-194 (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services carry a copay ranging from $0 to $450, while outpatient substance abuse sessions require a $25 to $35 copay, with prior authorization required for most services.
Partial Hospitalization See details
HumanaChoice Giveback H5216-194 (PPO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under HumanaChoice Giveback H5216-194 (PPO) are partially covered, as transportation services to plan-approved or health-related locations are not covered. Medicare-covered ground ambulance services require a $335 copay and air ambulance services require a $1,250 copay, with no coinsurance for either service.
Emergency Services See details
Emergency services are covered by HumanaChoice Giveback H5216-194 (PPO) 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 for a $130 copay and no coinsurance.
Primary Care See details
Primary Care benefits under the HumanaChoice Giveback H5216-194 (PPO) plan include primary care physician visits and telehealth services with no copay and no coinsurance. Other covered services feature no coinsurance but require copays, such as $65 for specialists, $45 for physical, occupational, and speech therapies, and $25 for mental health and psychiatric sessions, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Giveback H5216-194 (PPO) covers preventive services, including annual physicals, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered; a fitness benefit is included with no copay and no coinsurance, but health education, PERS, in-home safety, medical nutrition, 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 modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice Giveback H5216-194 (PPO) covers Medicare-covered hearing exams for a $65 copay and routine exams and fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H5216-194 (PPO) vision services are partially covered, offering one routine eye exam and one pair of eyeglasses (lenses and frames) or contact lenses per year with no copay, no coinsurance, and no deductible. Prior authorization is required, with annual limits of $75 for exams and $150 for eyewear, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5216-194 (PPO) offers partially covered dental services with a $1,500 annual maximum benefit, featuring no copay and no coinsurance for preventive care, a $25 copay and no coinsurance for restorative services, and a $65 copay and no coinsurance for Medicare-covered dental. Fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice Giveback H5216-194 (PPO) with no copay and no coinsurance, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice Giveback H5216-194 (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HumanaChoice Giveback H5216-194 (PPO), with durable medical equipment and prosthetics requiring a 20% coinsurance and no copay. Diabetic supplies feature 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 H5216-194 (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab services and outpatient X-rays, though X-rays carry 20% coinsurance. Diagnostic procedures and tests require a $0 to $65 copay and 20% coinsurance, while therapeutic radiology requires a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-194 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice Giveback H5216-194 (PPO) does not cover cardiac rehabilitation services, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-194 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
HumanaChoice Giveback H5216-194 (PPO) partially covers other services, offering acupuncture with a $65 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Both of these covered benefits require prior authorization, while over-the-counter (OTC) items are not covered.
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