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HumanaChoice Giveback H5216-319 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-319 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-319 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-319 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in New Jersey. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-319 (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 H5216-319 (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 H5216-319 (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 $103.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $380.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $360.00 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 $9000.00 (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 $9000.00 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 H5216-319 (PPO) plan features an annual drug deductible of $360. For Tier 1 preferred generic drugs, members pay no copay at standard pharmacies and through preferred mail order for both 1-month and 3-month supplies. Tier 2 generic drugs are also highly affordable, costing as little as a $1 copay for a 1-month supply, or no copay for a 3-month supply when using preferred mail order. For Tier 3 preferred brand drugs, copays start at $30 for a 1-month supply at standard pharmacies or preferred mail order. Higher-tier medications require coinsurance instead of flat copays, with Tier 4 non-preferred drugs requiring 29% coinsurance and Tier 5 specialty drugs requiring 28% coinsurance. These structured costs help you budget effectively for your prescription medication needs throughout the plan year.
Additional Benefits
The HumanaChoice Giveback H5216-319 (PPO) plan offers robust coverage with no copay for primary care physician visits, annual physicals, and home health services. For hospital care, members pay a daily copay of $275 for the first seven days of acute inpatient stays and up to a $500 copay for outpatient services, both with no coinsurance. Emergency medical services are covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. Specialist visits require a $45 copay, while routine dental, vision, and hearing exams are covered with no copay. Dental services feature a $1,500 annual coverage limit, and prescription hearing aids require copays ranging from $699 to $999. Additionally, diagnostic lab tests and outpatient X-rays are available with no copay, while durable medical equipment is covered with a 12% coinsurance.
Inpatient Hospital See details
HumanaChoice Giveback H5216-319 (PPO) partially covers inpatient hospital services with no coinsurance, charging a $275 daily copay for days 1-7 of acute stays and a $225 daily copay for days 1-7 of psychiatric stays, followed by no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-319 (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $500 and observation services with a $275 copay per stay. Outpatient substance abuse services require a $35 copay and no coinsurance, while ambulatory surgical center and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice Giveback H5216-319 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-319 (PPO) covers ground and air ambulance services with a $310 copay and no coinsurance per service, subject to prior authorization. Transportation services, including trips to plan-approved or other health-related locations, are not covered.
Emergency Services See details
HumanaChoice Giveback H5216-319 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay 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, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-319 (PPO) primary care benefits feature no copay and no coinsurance for primary care physician visits, a $45 copay with no coinsurance for specialists, and $20 to $35 copays with no coinsurance for physical, occupational, and speech therapies. Mental health, psychiatric, and opioid treatments require a $35 copay with no coinsurance, telehealth ranges from no copay to a $45 copay with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice Giveback H5216-319 (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, memory fitness, and select screenings. However, supplemental services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice Giveback H5216-319 (PPO), offering Medicare-covered exams for a $45 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, though OTC, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice Giveback H5216-319 (PPO), offering covered eye exams with no copay to a $45 copay and eyewear with no copay, both with no coinsurance. While routine eye exams, contact lenses, and eyeglasses are covered up to annual limits, other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5216-319 (PPO) dental services are partially covered up to a $1,500 annual limit for combined in-network and out-of-network care, featuring no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental services require a $45 copay and no coinsurance, while fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-319 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, covered Part B drugs, such as chemotherapy and radiation, require between no coinsurance and 20% coinsurance, while covered insulin requires a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice Giveback H5216-319 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice Giveback H5216-319 (PPO) covers medical equipment, offering durable medical equipment (DME) with a 12% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the HumanaChoice Giveback H5216-319 (PPO) plan, though prior authorization is required. There is no copay for lab services and outpatient X-rays, diagnostic procedures range from no copay to a $100 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice Giveback H5216-319 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by HumanaChoice Giveback H5216-319 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered, with applicable copayments ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice Giveback H5216-319 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Giveback H5216-319 (PPO) partially covers other services, offering up to 20 acupuncture treatments per year with a $45.00 copay and no coinsurance, though prior authorization is required. Supplemental benefits such as over-the-counter (OTC) items and meal benefits are not covered.
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