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HumanaChoice Giveback H5216-226 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-226 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-226 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-226 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Kentucky and Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-226 (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 H5216-226 (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 H5216-226 (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 $31.00. 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 H5216-226 (PPO) prescription drug plan has 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 are also cost-effective, offering no copay for a 3-month supply through preferred mail order and a low $5 copay for a 1-month supply at standard pharmacies. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, or a reduced $131 copay for a 3-month supply via preferred mail order. Tier 4 non-preferred drugs require a 50% coinsurance for both 1-month and 3-month supplies. Lastly, Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply across all standard pharmacy and mail order options.
Additional Benefits
The HumanaChoice Giveback H5216-226 (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and home health care. Specialist visits and urgent care require a $50 copay, while emergency room care carries a $115 copay. For hospital stays, there is no coinsurance, though patients pay a $470 daily copay for the first few days of inpatient care and no copay for the first 20 days in a skilled nursing facility. This plan also includes key ancillary benefits, such as dental coverage with no copay for preventive services up to a $1,500 annual limit, and vision care featuring no copay for routine exams and eyewear up to specific limits. Hearing benefits include annual routine exams with no copay and coverage for up to two hearing aids per year with copays between $699 and $999. Additionally, durable medical equipment is covered with no copay and a 17% coinsurance, helping to keep your out-of-pocket costs predictable.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by HumanaChoice Giveback H5216-226 (PPO) with no coinsurance, requiring a $470 daily copay for days 1 through 5 for acute stays and days 1 through 4 for psychiatric stays, with no copay for subsequent days. While unlimited additional acute stay days are covered at no copay, additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-226 (PPO) covers outpatient services with no coinsurance, including a $0 to $470 copay for outpatient hospital services, a $470 copay per stay for observation services, and a $35 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice Giveback H5216-226 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-226 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Giveback H5216-226 (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 $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under the HumanaChoice Giveback H5216-226 (PPO) include primary care physician services with no copay and no coinsurance, and specialist visits for a $50 copay and no coinsurance. Therapy and outpatient mental health services require a $35 copay and no coinsurance, while podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services under HumanaChoice Giveback H5216-226 (PPO) are covered with no copay and no coinsurance, which includes annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. While some additional preventive services are covered, in practice, sub-services such as fitness benefits, health education, weight management, and nutrition therapy are not covered.
Hearing Services See details
HumanaChoice Giveback H5216-226 (PPO) covers Medicare-covered hearing exams with a $50 copay and no coinsurance, while routine annual exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $699 to $999 and no coinsurance for up to two devices per year, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H5216-226 (PPO) partially covers vision services with no copay, no coinsurance, and no deductible, though prior authorization is required. Covered benefits include one routine eye exam per year (up to $75) and eyeglasses or contact lenses (up to a combined $100 yearly limit), while other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5216-226 (PPO) dental services are partially covered, offering up to a $1,500 annual limit with no copay and no coinsurance for preventive care, while Medicare-covered dental requires a $50 copay and no coinsurance. Comprehensive options like restorative care require no copay with a 30% to 40% coinsurance, but fluoride, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice Giveback H5216-226 (PPO) with no copay, requiring prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
HumanaChoice Giveback H5216-226 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
HumanaChoice Giveback H5216-226 (PPO) covers durable medical equipment (DME) with a 17% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice Giveback H5216-226 (PPO) with prior authorization, featuring no copays for lab services and outpatient X-rays. Diagnostic procedures have a $0 to $105 copay with no coinsurance, while therapeutic radiological services require a minimum $45 copay and a minimum 20% coinsurance.
Home Health Services See details
HumanaChoice Giveback H5216-226 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice Giveback H5216-226 (PPO) with a $10 copay and no coinsurance, requiring prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-226 (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
HumanaChoice Giveback H5216-226 (PPO) covers acupuncture with a $50 copay, no coinsurance, and a limit of 20 treatments per year, alongside chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for both of these covered services, while over-the-counter (OTC) items are not covered.
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