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Humana Full Access Giveback H5216-311 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access Giveback H5216-311 (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 H5216-311 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access Giveback H5216-311 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Southeast Florida. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Full Access Giveback H5216-311 (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 H5216-311 (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 H5216-311 (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 $174.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $50.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $350.00 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 $6200.00 (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 $6200.00 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 H5216-311 (PPO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy used. For preferred generic drugs, the copay is $5 at preferred mail order pharmacies and $20 at standard mail order pharmacies. For standard generic drugs, the copay is $47, regardless of the pharmacy. For preferred brand drugs, the coinsurance is 38%, and for non-preferred drugs, the coinsurance is 28%. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Full Access Giveback H5216-311 (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with varying copays depending on the service. You'll find no copay for primary care visits, preventive services, and many other services. Additional benefits include hearing and vision coverage, with copays for exams and no copays for eyewear. Dental services are also covered, including oral exams and cleanings with no copays, and restorative services with a copay. Ambulance, emergency, and home health services are covered, as well as skilled nursing facility and cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care. For Inpatient Hospital-Acute, you pay a $400 copay for days 1-7, and no copay for days 8-90; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has a $400 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $295, Observation Services have a $400 copay, Ambulatory Surgical Center Services have no copay, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $30 and $55.
Partial Hospitalization See details
Partial Hospitalization is covered with a $35 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Full Access Giveback H5216-311 (PPO) plan. Ground ambulance services have a copay of $120-$240, while air ambulance services have a 20% 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 under the Humana Full Access Giveback H5216-311 (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, while Urgently Needed Services have a $15 copay.
Primary Care See details
The Humana Full Access Giveback H5216-311 (PPO) plan offers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $45 copay. Physician specialist services have a $40 copay, while mental health and psychiatric services have a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $45 copay, additional telehealth benefits have a copay between $0-$40, and opioid treatment program services have a copay between $30-$55.
Preventive Services See details
Preventive Services include no copay for an annual physical exam and additional preventive services, including Fitness Benefit, with no copay for Memory Fitness, and no copay for Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $40 copay and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per ear annually, and OTC hearing aids are covered with no copay and a maximum benefit of $500 per ear annually. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Full Access Giveback H5216-311 (PPO) plan covers dental services, including oral exams with no coinsurance and no copay, up to 3 times per year. Other services include dental x-rays and other diagnostic dental services with no coinsurance, and prophylaxis (cleaning) with no coinsurance, as well as restorative services with a $25 copay. However, fluoride treatment, endodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%. Prior authorization is required for coverage.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 13% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 20% coinsurance, and no copay. Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay and coinsurance, and all radiological services, with a copay and coinsurance. Diagnostic Procedures/Tests have a maximum copay of $150 and at least 20% coinsurance, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $250, Therapeutic Radiological Services have a maximum copay of $40 and at least 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Full Access Giveback H5216-311 (PPO) plan with no copay and no coinsurance, although additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, requiring prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $160.
Other Services See details
Other Services include acupuncture and a meal benefit. Acupuncture has no copay and is limited to 25 treatments per year with prior authorization required. The meal benefit also has no copay and requires prior authorization. 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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