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HumanaChoice Giveback H5216-322 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-322 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-322 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-322 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Kentucky and Southern Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-322 (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 H5216-322 (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 H5216-322 (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 $129.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $430.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 $13900.00 (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 $13900.00 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 H5216-322 (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays starting at $2 and no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 31% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. Standard mail order options for Tier 1 and Tier 2 drugs carry higher copays, ranging from $10 to $60 depending on the supply.
Additional Benefits
The HumanaChoice Giveback H5216-322 (PPO) plan provides comprehensive coverage for core medical needs with many services featuring no copay or low fixed costs. You will pay no copay for primary care doctor visits and annual physical exams, while specialist visits require a $40 copay. Emergency room visits carry a $115 copay, which is waived if you are admitted, and outpatient hospital services range from no copay up to a $400 copay. For routine wellness, the plan offers dental cleanings, routine vision exams, and routine hearing exams with no copay, though annual limits and copays apply to restorative dental care and prescription hearing aids. Skilled nursing facility care features no copay for the first 20 days, and durable medical equipment is covered with a 9% coinsurance. Other essential services like home health care and lab services are also available with no copay.
Inpatient Hospital See details
HumanaChoice Giveback H5216-322 (PPO) covers inpatient hospital services with no coinsurance, featuring a $400 daily copay for days 1-5 of acute stays (no copay for days 6 and beyond) and a $400 daily copay for days 1-4 of psychiatric stays (no copay for days 5-90). Prior authorization is required, and upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-322 (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital copays range from no copay to $400 (with a $400 copay per observation stay), while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
HumanaChoice Giveback H5216-322 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-322 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
HumanaChoice Giveback H5216-322 (PPO) covers emergency services with a $115 copay and no coinsurance, which is 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 each require a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-322 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, and opioid treatment services require a $35 copay and no coinsurance, while telehealth and other health professionals have copays ranging from $0 to $40 with no coinsurance. Some chiropractic services are covered, though routine and other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
HumanaChoice Giveback H5216-322 (PPO) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and memory fitness. However, various supplemental services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, home modifications, and counseling.
Hearing Services See details
HumanaChoice Giveback H5216-322 (PPO) hearing services are partially covered with no deductible and no coinsurance. Medicare-covered exams require a $40 copay, while routine exams and fitting evaluations have no copay. Prescription hearing aids are partially covered with copays ranging from $699 to $999, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H5216-322 (PPO) partially covers vision services with no coinsurance, offering one routine eye exam and one pair of contact lenses or eyeglasses (lenses and frames) per year with no copay. Annual maximum benefits of $75 for exams and $100 for eyewear apply, but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5216-322 (PPO) provides partially covered dental services with a combined annual maximum benefit of $500 for both in- and out-of-network care. Diagnostic and preventive services like cleanings and exams have no copay and no coinsurance, while restorative services have a $25 copay and Medicare-covered dental has a $40 copay, both with no coinsurance. Fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-322 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
HumanaChoice Giveback H5216-322 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice Giveback H5216-322 (PPO) covers durable medical equipment (DME) with a 9% coinsurance and no copay. Prosthetics and medical supplies are covered with a 20% coinsurance and no copay, while diabetic supplies feature a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice Giveback H5216-322 (PPO), featuring no copay for lab services and outpatient X-rays, and no coinsurance for diagnostic tests which carry a copay of $0 to $100. Diagnostic radiological services have copays starting at $0, while therapeutic radiological services require a minimum $50 copay and 20% coinsurance, with prior authorization required.
Home Health Services See details
Home Health Services are covered by HumanaChoice Giveback H5216-322 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice Giveback H5216-322 (PPO) does not cover Cardiac Rehabilitation Services, as none of the associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice Giveback H5216-322 (PPO) with no coinsurance, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no prior 3-day inpatient hospital stay required and no coverage for additional days.
Other Services See details
HumanaChoice Giveback H5216-322 (PPO) partially covers other services, offering acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, as well as a meal benefit with no copay or coinsurance. Over-the-counter (OTC) items are not covered, and prior authorization is required for the covered services.
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