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Humana Full Access Giveback H5216-306 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access Giveback H5216-306 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access Giveback H5216-306 (PPO) in 2026, please refer to our full plan details page.
Humana Full Access Giveback H5216-306 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Michigan. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Full Access Giveback H5216-306 (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 Humana Full Access Giveback H5216-306 (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 Humana Full Access Giveback H5216-306 (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 $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 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 $13900.00 (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 $13900.00 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 Humana Full Access Giveback H5216-306 (PPO) prescription drug plan features a $0 drug deductible, meaning your coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. If you choose standard mail order, Tier 1 drugs carry a $10 copay for a 1-month supply and Tier 2 drugs carry a $20 copay for a 1-month supply. For Tier 3 preferred brand drugs, copays start at $30 for a 1-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. Tier 4 non-preferred drugs require a 35% coinsurance across standard pharmacies and mail order options for both 1-month and 3-month fills. Tier 5 specialty drugs are subject to a 33% coinsurance for a 1-month supply across all available pharmacy and mail order channels.
Additional Benefits
The Humana Full Access Giveback H5216-306 (PPO) plan offers affordable healthcare coverage with no copay for primary care doctor visits, routine preventive services, and home health care. For more specialized care, members can expect a $50 copay for specialist visits, a $115 copay for emergency room services, and a $400 daily copay for the first few days of inpatient hospital stays. Outpatient hospital care ranges from no copay to a $400 copay, while dialysis and durable medical equipment require a coinsurance of up to 20 percent. In addition to core medical care, this plan provides valuable supplemental benefits, including routine vision exams, OTC hearing aids, and preventive dental care up to a $2,000 annual maximum with no copay. Skilled nursing facility stays require no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Members also benefit from acupuncture visits for a $50 copay, alongside over-the-counter items and chronic illness meals with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Full Access Giveback H5216-306 (PPO) with no coinsurance, requiring a $400 daily copay for days 1 to 5 of an acute stay and days 1 to 4 of a psychiatric stay, with no copay for subsequent days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Full Access Giveback H5216-306 (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $400 copay and observation services with a $400 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Full Access Giveback H5216-306 (PPO) plan, requiring a $35.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Humana Full Access Giveback H5216-306 (PPO) covers Medicare-covered ground and air ambulance services with a $305 copay and no coinsurance, subject to prior authorization. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Humana Full Access Giveback H5216-306 (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 require a $40 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Full Access Giveback H5216-306 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $50 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with copays ranging from $20 to $35 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Full Access Giveback H5216-306 (PPO) covers preventive services, including annual physicals, kidney disease education, glaucoma screenings, and diabetes self-management training, with no copay and no coinsurance. Additional benefits like memory fitness and chemotherapy wigs (up to $500) are also covered with no copay, though prior authorization is required. However, this benefit is only partially covered as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, 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 safety modifications, and counseling are not covered.
Hearing Services See details
Humana Full Access Giveback H5216-306 (PPO) covers hearing services with no coinsurance, offering routine exams, fittings, and OTC hearing aids with no copay, and Medicare-covered exams for a $50 copay. Prescription hearing aids are partially covered with copays ranging from $399 to $999 for up to two devices per year, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Full Access Giveback H5216-306 (PPO) offers partially covered vision services with no deductibles and no coinsurance, including no copay for one annual routine eye exam (up to $75) and no copay for one annual pair of eyeglasses or contact lenses (up to a combined $100 limit). Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Full Access Giveback H5216-306 (PPO) offers partially covered dental services up to a $2,000 annual maximum, with a $50 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive, restorative, and periodontal care. Fluoride treatments, endodontics, prosthodontics, implants, maxillofacial prosthetics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Full Access Giveback H5216-306 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Full Access Giveback H5216-306 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Humana Full Access Giveback H5216-306 (PPO) covers durable medical equipment with a 13% 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.
Diagnostic and Radiological Services See details
Humana Full Access Giveback H5216-306 (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for diagnostic radiological services and no copay (with applicable coinsurance) for lab and outpatient X-ray services. Diagnostic procedures and tests require a 20% coinsurance and copays up to $105, while therapeutic radiological services carry a 20% coinsurance and copays starting at $45.
Home Health Services See details
Humana Full Access Giveback H5216-306 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Full Access Giveback H5216-306 (PPO) technically offers Cardiac Rehabilitation Services with no coinsurance, but in practice, the benefit is not covered. Specific sub-services, including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD), are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Humana Full Access Giveback H5216-306 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered by the Humana Full Access Giveback H5216-306 (PPO) include acupuncture for a $50 copay and no coinsurance, up to 20 treatments annually. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance.
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