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HumanaChoice Giveback H5216-264 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-264 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-264 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-264 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Arkansas and Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-264 (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 H5216-264 (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 H5216-264 (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 $102.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $375.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $11000.00 (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 $11000.00 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 H5216-264 (PPO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100.00, you will pay no copay for Tier 1 preferred generic drugs at standard pharmacies or through preferred mail order. For Tier 2 standard generic drugs, you will pay a $30.00 copay at standard pharmacies and preferred mail, or a $47.00 copay through standard mail. For higher-tier medications, Tier 3 preferred brands require a 35% coinsurance and Tier 4 non-preferred drugs require a 33% coinsurance across standard pharmacies and mail services. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy can benefit from a reduced premium and pay nothing for their Part D coverage.
Additional Benefits
The HumanaChoice Giveback H5216-264 (PPO) plan provides comprehensive medical coverage with no copay for primary care visits, annual physicals, or home health services. For specialized medical care, members will pay a $35 copay for specialist visits, acupuncture, and Medicare-covered dental or hearing exams. Inpatient hospital stays require a daily copay of $360 for days 1 through 6, which drops to no copay for days 7 through 999. Ancillary benefits include annual routine hearing exams and vision exams with no copay, alongside a $2,000 annual limit for covered dental services with no copay. Diagnostic services like lab tests and outpatient X-rays also have no copay, though more complex procedures and medical equipment like DME require coinsurance ranging from 10% to 20%. Emergency care is covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
HumanaChoice Giveback H5216-264 (PPO) partially covers inpatient hospital benefits, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $360 daily copay for days 1 to 6 and no copay for days 7 to 999, while psychiatric stays require a $318 daily copay for days 1 to 6 and no copay for days 7 to 90, with no coinsurance for either benefit.
Outpatient Services See details
HumanaChoice Giveback H5216-264 (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most services. Patients will pay a copay of $30 to $35 for outpatient substance abuse sessions and up to $360 for outpatient hospital and observation services, while ambulatory surgical center and blood services have no copay.
Partial Hospitalization See details
HumanaChoice Giveback H5216-264 (PPO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-264 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services are not covered, including trips to plan-approved or other health-related locations.
Emergency Services See details
HumanaChoice Giveback H5216-264 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-264 (PPO) offers partially covered Primary Care benefits, featuring no copay and no coinsurance for primary care visits, and a $35 copay and no coinsurance for specialists and therapy services. Mental health, psychiatric, and opioid treatment sessions carry a $30 to $35 copay with no coinsurance, while telehealth and other professional services range from no copay to a $40 copay with no coinsurance. Podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice Giveback H5216-264 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and memory fitness benefits. However, the plan's additional preventive benefits are only partially covered, as sub-services such as health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice Giveback H5216-264 (PPO), featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Covered prescription hearing aids require a $699 to $999 copay and no coinsurance, though OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice Giveback H5216-264 (PPO) covers eye exams with a $0 to $35 copay and no coinsurance, up to a $75 annual limit. Eyewear is partially covered with no copay and no coinsurance up to a $200 annual limit, though individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5216-264 (PPO) partially covers dental services with a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,000 annual limit. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice Giveback H5216-264 (PPO) with prior authorization. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance with no deductible, while chemotherapy, radiation, and other Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice Giveback H5216-264 (PPO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice Giveback H5216-264 (PPO) with prior authorization, including durable medical equipment (DME) at a 10% coinsurance and no copay. Prosthetics and medical supplies require a 13% coinsurance, while diabetic supplies carry a 10% to 20% coinsurance with no copay, and diabetic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the HumanaChoice Giveback H5216-264 (PPO) plan, with prior authorization required. Lab and outpatient X-ray services have no copay and no coinsurance, while diagnostic procedures require a copay of up to $90 and no coinsurance. Diagnostic radiological services carry a copay of up to $360 with no coinsurance, and therapeutic radiological services require a $50 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice Giveback H5216-264 (PPO) with no copay and no coinsurance. Prior authorization is required before you can receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically offered by HumanaChoice Giveback H5216-264 (PPO), but in practice, some services are covered while Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. There is no copay or coinsurance for these non-covered rehabilitation services.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-264 (PPO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond what Medicare covers are not covered. Stays require prior authorization and feature no copay and no coinsurance for days 1 to 20, followed by a $218 copay and no coinsurance for days 21 to 100.
Other Services See details
Other Services are partially covered by HumanaChoice Giveback H5216-264 (PPO), which features acupuncture for a $35 copay and no coinsurance, alongside meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items and dual eligible SNP services are not covered under this benefit.
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