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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 2026, 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 2026.
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 $171.00. 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 a $600.00 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 $6700.00 (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 $6700.00 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) prescription drug plan features an annual drug deductible of $600. For Tier 1 preferred generic drugs, there is no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with a $5 copay for a 1-month supply and no copay for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply at standard pharmacies and mail order options. Higher-tier medications require coinsurance instead of a flat copayment, with Tier 4 non-preferred drugs requiring 35% coinsurance and Tier 5 specialty drugs requiring 26% coinsurance.
Additional Benefits
The Humana Full Access Giveback H5216-311 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. Specialist visits require a $45 copay, while inpatient hospital stays require a $350 daily copay for the first 5 to 7 days and no copay for subsequent days. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital. For supplemental wellness, this plan features no copay for preventive dental care, routine hearing exams, and covered eyewear, with dental benefits capped at a $1,000 annual limit. Diagnostic lab tests and outpatient X-rays also require no copay, while durable medical equipment carries a 10% coinsurance. Prescription hearing aids are partially covered up to a $500 annual limit per ear to help lower your personal healthcare expenses.
Inpatient Hospital See details
Humana Full Access Giveback H5216-311 (PPO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 7 of acute stays (no copay for days 8 and beyond) and days 1 to 5 of psychiatric stays (no copay for days 6 to 90). 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 H5216-311 (PPO) covers outpatient services with no coinsurance, though copays vary by service and prior authorization is generally required. Under this plan, there is no copay for ambulatory surgical center and blood services, a $30 to $35 copay for outpatient substance abuse sessions, and a $0 to $350 copay for outpatient hospital and observation services.
Partial Hospitalization See details
Humana Full Access Giveback H5216-311 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Humana Full Access Giveback H5216-311 (PPO) plan, with ground ambulance services requiring a $120.00 to $335.00 copay and air ambulance services requiring a 20% coinsurance. Prior authorization is required for all ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Humana Full Access Giveback H5216-311 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Full Access Giveback H5216-311 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Additional covered benefits include physical, occupational, and mental health therapies with copays ranging from $30 to $35 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Full Access Giveback H5216-311 (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, glaucoma screenings, and memory fitness. Supplemental options such as health education, in-home safety assessments, PERS, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, and counseling are not covered.
Hearing Services See details
Humana Full Access Giveback H5216-311 (PPO) covers routine hearing exams and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams have a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $500 annual limit per ear, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Full Access Giveback H5216-311 (PPO) vision services are partially covered, featuring eye exams with a $0 to $45 copay and no coinsurance, and covered eyewear with no copay and no coinsurance. Other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Full Access Giveback H5216-311 (PPO) offers partially covered dental services up to a $1,000 annual limit, featuring no copay and no coinsurance for preventive care, a $25 copay and no coinsurance for restorative services, and a $45 copay and no coinsurance for Medicare-covered dental. However, fluoride, endodontics, periodontics, implants, oral surgery, orthodontics, and prosthodontics are not covered.
Home Infusion bundled Services See details
Humana Full Access Giveback H5216-311 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while Part B insulin drugs have a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Humana Full Access Giveback H5216-311 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Full Access Giveback H5216-311 (PPO) covers durable medical equipment and prosthetic devices with no copay and 10% coinsurance. Medical supplies and diabetic supplies are covered with no copay and 20% coinsurance, while diabetic therapeutic shoes or inserts require a $5 copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Full Access Giveback H5216-311 (PPO) covers diagnostic and radiological services with prior authorization, featuring no copays for lab services, diagnostic radiology, and outpatient X-rays. Diagnostic procedures and tests require a 20% coinsurance and a copay up to $150, while therapeutic radiological services carry a 20% coinsurance and a copay starting at $40.
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 prior authorization is required.
Cardiac Rehabilitation Services See details
Some cardiac rehabilitation services are covered under the Humana Full Access Giveback H5216-311 (PPO) with no copay and no coinsurance, although prior authorization is required. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Humana Full Access Giveback H5216-311 (PPO) with no coinsurance and no required three-day prior hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and a $160 copay per day for days 21 through 100, while additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by Humana Full Access Giveback H5216-311 (PPO), featuring acupuncture limited to 25 treatments per year and chronic illness meal benefits, both with no copay, no coinsurance, and prior authorization requirements. Over-the-counter (OTC) items are not covered under this plan.
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