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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 2025, 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 2025.
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 $48.00. 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 $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 $9550.00 (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 $9550.00 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) plan has a $365 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for a 30-day supply, you will pay an $8 copay for preferred generic drugs at a standard pharmacy, and 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice Giveback H5216-194 (PPO) plan offers a variety of benefits with varying costs. This plan includes coverage for inpatient hospital stays with a copay, outpatient services, emergency services, and primary care visits, many with no copay. The plan also covers preventive services, hearing and vision exams and eyewear with no copay, and dental services with a $1,500 annual maximum. Additional benefits include ambulance services, home health services, and some medical equipment with copays or coinsurance. The plan also covers some prescription drugs, home infusion services, and dialysis services. Other covered services include acupuncture, a meal benefit, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $450 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days (91-999) have no copay and no coinsurance. For Inpatient Hospital Psychiatric, you pay a $450 copay for days 1-5, and no copay for days 6-90, with no coinsurance.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a $0-$400 copay and 20% coinsurance, Observation Services with a $450 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with 20% coinsurance and a $30 copay, and Outpatient Blood Services with no copay. Individual and group sessions for outpatient substance abuse have a 20% coinsurance and a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the HumanaChoice Giveback H5216-194 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice Giveback H5216-194 (PPO) plan, but Transportation Services to any health-related location are not covered. Medicare-covered ground ambulance services have a $315 copay, and Medicare-covered air ambulance services have a $1250 copay; both have no coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice Giveback H5216-194 (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $55 copay and no coinsurance, and Worldwide Emergency Services have a $125 copay.
Primary Care See details
The HumanaChoice Giveback H5216-194 (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $45 copay, Physician Specialist Services with a $65 copay, and Physical Therapy and Speech-Language Pathology Services with a $45 copay. Mental Health Specialty Services and Psychiatric Services have a $30 copay for individual and group sessions. The plan also covers Additional Telehealth Benefits with a copay between $0 and $65, and Opioid Treatment Program Services with a copay of $30 and 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services, including Fitness Benefit. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $65 copay and require prior authorization, and fitting/evaluation for hearing aids and routine hearing exams have no copay. Prescription hearing aids (all types) have a copay between $699 and $999 per year, and OTC hearing aids are covered up to $25 every three months. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The HumanaChoice Giveback H5216-194 (PPO) plan covers eye exams with a copay between $0 and $65. The plan also covers eyewear, including contact lenses and eyeglasses, with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered by the HumanaChoice Giveback H5216-194 (PPO) plan, with a $1,500 annual maximum benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, while restorative services have a $25 copay. Fluoride treatment, 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 and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Giveback H5216-194 (PPO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 10% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have a coinsurance between 10% and 20%, with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered procedures and lab services, and a coinsurance for diagnostic procedures/tests of at most 20%. Lab services have no copay. Radiological Services include coverage for diagnostic and therapeutic services, with a copay of at most $350 for diagnostic services and a coinsurance of at most 20% for therapeutic services. Outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-194 (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 specific services like 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 are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Giveback H5216-194 (PPO) plan. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $65 copay, and a meal benefit with no copay. This plan also covers over-the-counter (OTC) items, with a maximum benefit coverage amount of $25 every three months, and it offers nicotine replacement therapy. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and several other services are not covered.
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