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HumanaChoice Giveback H5216-309 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-309 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-309 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-309 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Indiana, Ohio, & N KY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-309 (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 H5216-309 (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 H5216-309 (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 $124.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $425.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $510.00 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 H5216-309 (PPO) plan has a $510 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you can expect a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy. Standard generic drugs have a $47 copay, while preferred brand drugs have a 50% coinsurance. Non-preferred drugs have a 26% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice Giveback H5216-309 (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care and preventive services, and a $40 copay for hearing exams. This plan also covers emergency services, ambulance services, and home health services, with copays ranging from $0 to $315. Additional benefits include vision and dental coverage with copays, medical equipment, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $400 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute. Additional days for Inpatient Hospital-Acute have no copay, but non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric has a $400 copay for days 1-4 and no copay for days 5-90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $400, observation services with a $400 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a copay between $40 and $100 for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice Giveback H5216-309 (PPO) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The HumanaChoice Giveback H5216-309 (PPO) plan covers ambulance services, including both ground and air ambulance, with a $315 copay for each service and no coinsurance. 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. Emergency Services have a $100 copay, while Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $100 copay.
Primary Care See details
The HumanaChoice Giveback H5216-309 (PPO) plan covers Primary Care Physician Services and Chiropractic Services with no copay. Occupational Therapy Services have a copay between $20 and $35, and Physician Specialist Services have a $40 copay. Additionally, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a copay between $20 and $35. Additional Telehealth Benefits are covered with a copay between $0 and $45. However, Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services and an annual physical exam with no copay, and additional services requiring prior authorization, with costs varying by service. Additional services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services are partially covered by the HumanaChoice Giveback H5216-309 (PPO) plan. Hearing exams have a $40 copay, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids of all types, inner ear hearing aids, outer ear hearing aids, over the ear hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $40, with no coinsurance. Eyewear is covered with no copay and no coinsurance, but eyeglasses, contact lenses, and upgrades are not covered.
Dental Services See details
Dental services are covered under HumanaChoice Giveback H5216-309 (PPO), with a $40 copay for Medicare Dental Services. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice Giveback H5216-309 (PPO), including insulin and other Medicare Part B drugs. Medicare Part B insulin drugs have a $35 copay with a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Giveback H5216-309 (PPO) plan, but require prior authorization. This plan has a coinsurance between 20% and 20% for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), is covered by the HumanaChoice Giveback H5216-309 (PPO) plan with no coinsurance and no copay. Prosthetics and medical supplies have a 10% coinsurance, while diabetic supplies have a 10-20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $105, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $325, and Therapeutic Radiological Services have a coinsurance of at most 20% and no copay. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-309 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice Giveback H5216-309 (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Giveback H5216-309 (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice Giveback H5216-309 (PPO) plan covers acupuncture with a $40 copay and a limit of 20 treatments per year, and meal benefits 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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