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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 2025, 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 New Jersey. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $95.00. 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 $590.00 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 has a $590 deductible for prescription drugs. After meeting your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy, and 29% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The HumanaChoice Giveback H5216-319 (PPO) plan offers a variety of benefits with varying costs. Many services have no copay, including primary care visits, preventive services such as annual physical exams, routine hearing exams, and vision exams, as well as dental services such as oral exams and x-rays. The plan also covers inpatient hospital stays, outpatient services, and emergency services, with copays ranging from $45 to $395. This plan also provides coverage for services like ambulance, hearing, vision, and dental, with specific copays and coinsurance amounts depending on the service. Home health services, durable medical equipment, and lab services have no copay. However, some services, such as skilled nursing facilities, partial hospitalization, and dialysis services, may require prior authorization and have associated copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $275 copay for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a $225 copay for days 1-7 and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $395, observation services have a $275 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay between $40 and $100, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice Giveback H5216-319 (PPO) plan. There is a $60 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
For the HumanaChoice Giveback H5216-319 (PPO) plan, ambulance services are covered with a $315 copay for both ground and air ambulance services, 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 under the HumanaChoice Giveback H5216-319 (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay; there is no coinsurance for either service. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice Giveback H5216-319 (PPO) plan covers primary care physician services with no copay and chiropractic services with a $15 copay. Occupational therapy services have a copay between $20 and $35, while specialist visits have a $50 copay. Mental health and psychiatric individual and group sessions have a $40 copay, and physical therapy and speech-language pathology services have a copay between $20 and $35. Additional telehealth benefits have a copay between $0 and $50, and opioid treatment program services have a copay between $40 and $100.
Preventive Services See details
The HumanaChoice Giveback H5216-319 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. However, the plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, 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.
Hearing Services See details
Hearing Services include hearing exams with a $50 copay, and routine hearing exams with no copay for 1 visit every year. Fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a copay between $699 and $999 for 2 visits every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $50, and routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses, has no copay, and a combined maximum of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5216-319 (PPO) plan covers Medicare Dental Services with a $50 copay, and other dental services, with a maximum plan benefit of $1500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics fixed are covered with no copay, while fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Giveback H5216-319 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with no coinsurance and no copay. Prosthetic Devices have 8% coinsurance, while Medical Supplies have 10% coinsurance. Diabetic Supplies have 10% coinsurance and no copay, while 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 for Medicare-covered diagnostic procedures/tests and lab services. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Radiological services include a copay for Medicare-covered diagnostic and therapeutic radiological services, and X-ray services, with a maximum copay of $300 for Diagnostic Radiological Services, and a coinsurance of at most 20% and a copay of at most $50 for Therapeutic Radiological Services. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-319 (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice Giveback H5216-319 (PPO) plan, but not in practice. 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Giveback H5216-319 (PPO) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $214 copay; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, which has a $50 copay per visit and is limited to 20 treatments per year, but the plan does not cover over-the-counter items, meal benefits, or other listed services.
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