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HumanaChoice Giveback H5216-252 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-252 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-252 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-252 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Eastern Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-252 (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 H5216-252 (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 H5216-252 (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 $51.00. 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 $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 H5216-252 (PPO) plan features an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $10 copay for a 1-month supply at standard pharmacies, but you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail-order services. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 47% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. This clear pricing structure allows you to accurately anticipate your monthly and long-term medication costs.
Additional Benefits
The HumanaChoice Giveback H5216-252 (PPO) plan offers robust coverage for essential medical services with no copay for primary care visits, preventive screenings, and home health services. For specialist visits, patients will pay a $45 copay, while inpatient hospital stays require a $425 daily copay for the first five days and no copay thereafter. Emergency care is accessible with a $130 copay, which is waived upon hospitalization, and outpatient services feature a mix of no copay options and copays up to $300. Additional benefits include dental care with no copay or coinsurance up to a $2,000 annual limit, as well as routine vision and hearing exams with no copay. Prescription hearing aids require copays between $199 and $799, while durable medical equipment and dialysis services generally carry a 20% coinsurance with no copay. Skilled nursing facility stays are covered with daily copays of $10 for days 1 through 20 and $218 for days 21 through 100.
Inpatient Hospital See details
HumanaChoice Giveback H5216-252 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1 to 5 and no copay for days 6 and beyond for acute care (up to day 90 for psychiatric care). Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice Giveback H5216-252 (PPO) with no coinsurance, including no copay for ambulatory surgical center and blood services. Other services require prior authorization and carry copays, ranging from $0 to $300 for outpatient hospital services, $425 per stay for observation services, and $30 to $35 per session for outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization services are covered under the HumanaChoice Giveback H5216-252 (PPO) plan with a $35.00 copay and no coinsurance, subject to prior authorization.
Ambulance and Transportation Services See details
Ambulance services under the HumanaChoice Giveback H5216-252 (PPO) plan require prior authorization, costing a $335 copay with no coinsurance for ground transport and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Giveback H5216-252 (PPO) covers emergency services 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 care, and emergency transportation are all covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-252 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapy cost a $40 copay with no coinsurance, mental health and psychiatric sessions require a $30 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Giveback H5216-252 (PPO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered, with a memory fitness benefit included, while sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice Giveback H5216-252 (PPO), offering one annual routine exam and unlimited fitting evaluations with no copay and no coinsurance. Medicare-covered exams require a $45 copay and no coinsurance, while OTC hearing aids have no copay or coinsurance, and prescription hearing aids require a $199 to $799 copay and no coinsurance, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
HumanaChoice Giveback H5216-252 (PPO) vision services are partially covered, featuring no coinsurance for all services, no copay for eyewear, and copays ranging from no copay to $45 for eye exams. While routine eye exams, contact lenses, and eyeglasses are covered, other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the HumanaChoice Giveback H5216-252 (PPO) up to a $2,000 annual limit, offering no copay and no coinsurance for most preventive and comprehensive care, a $45 copay and no coinsurance for Medicare-covered dental, and a 30% coinsurance with no copay for prosthodontics. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-252 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin specifically featuring a $35 copay.
Dialysis Services See details
Dialysis services are covered by HumanaChoice Giveback H5216-252 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is covered by HumanaChoice Giveback H5216-252 (PPO), with durable medical equipment and prosthetics requiring 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.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5216-252 (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and no coinsurance. Diagnostic procedures and tests have a copay of $0 to $95 with no coinsurance, while diagnostic radiological services feature copays starting at $0 and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice Giveback H5216-252 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by HumanaChoice Giveback H5216-252 (PPO) with no coinsurance, but in practice some services are covered while cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($20 copay) are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by HumanaChoice Giveback H5216-252 (PPO) with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Under this plan, you will pay a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100, with prior authorization required and no prior three-day hospital stay needed.
Other Services See details
HumanaChoice Giveback H5216-252 (PPO) partially covers other services, including acupuncture for a $45 copay and no coinsurance, as well as over-the-counter items and meals for chronic illness with no copay and no coinsurance. Certain other additional services and dual eligible SNP services are not covered under this benefit.
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