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HumanaChoice Giveback H5216-308 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-308 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-308 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-308 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Virginia and Delaware. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-308 (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 H5216-308 (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 H5216-308 (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 $109.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $400.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $450.00 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 $14000.00 (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 $14000.00 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 H5216-308 (PPO) plan has a $450 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. In the initial coverage phase, you will pay a copay for generic drugs and coinsurance for brand-name drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice Giveback H5216-308 (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with a copay. This plan also covers primary care visits for a $10 copay, preventive services with no copay, and offers coverage for hearing, vision, and dental services with copays and coinsurance. Other benefits include home health services with no copay, and medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services, with a copay of $375 for days 1-5, and no copay for days 6-90 for acute, and a copay of $375 for days 1-4, and no copay for days 5-90 for psychiatric. Additional days for acute inpatient hospital have no copay, while non-Medicare covered stays and upgrades for acute and additional days and non-Medicare-covered stays for psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $450, Observation Services with a $375 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $45 and $85 for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice Giveback H5216-308 (PPO) plan. Ground and Air Ambulance Services have a $315 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice Giveback H5216-308 (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while all Worldwide Emergency Services have a $110 copay.
Primary Care See details
The HumanaChoice Giveback H5216-308 (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay (routine care not covered), occupational therapy with a $25 copay, physician specialist services with a $45 copay, mental health specialty services (individual and group sessions with a $45 copay), physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a copay between $45 and $85. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice Giveback H5216-308 (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services are covered, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit with 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 $45 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a copay between $699 and $999, while OTC hearing aids are not covered. Prescription hearing aids - inner ear, outer ear, and over the ear are also not covered.
Vision Services See details
The HumanaChoice Giveback H5216-308 (PPO) plan covers eye exams with a copay of $0-$45, and routine eye exams with no copay. Eyewear is covered with no copay, including contact lenses and eyeglasses (lenses and frames), but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5216-308 (PPO) plan covers Medicare dental services with a $45 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Adjunctive general services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Insulin drugs have a $35 copay and between 0% and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-308 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 6% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 15% coinsurance, and Medical Supplies also have a 15% coinsurance; there is no copay for either. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $100, and Lab Services with no copay. Radiological Services are also covered, including Diagnostic Radiological Services with a copay up to $325, Therapeutic Radiological Services with a copay up to $45 and coinsurance up to 20%, and Outpatient X-Ray Services with a $10 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
HumanaChoice Giveback H5216-308 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The HumanaChoice Giveback H5216-308 (PPO) plan covers acupuncture with a $45 copay, and a meal benefit with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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