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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 2025, 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 2025.
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 $124.00. 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 $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 $14000.00 (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 $14000.00 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 has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $20 copay for preferred generic drugs at standard or mail-order pharmacies. For non-preferred drugs, you will pay 25% coinsurance. Once your total yearly drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The HumanaChoice Giveback H5216-322 (PPO) plan offers coverage for a variety of services with varying costs. This plan includes inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $400, and emergency services with a $45-$100 copay. Primary care and preventive services like annual physical exams have no copay, while specialist visits have a $40 copay. Additional benefits include coverage for hearing and vision services, with copays ranging from $0-$40. Dental services are partially covered. Home health services and ambulance services are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a $400 copay for days 1-5, and no copay for days 6-90, as well as coverage for days 91-999 with no copay. Inpatient Hospital Psychiatric benefits are also covered, with a $400 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $400, observation services with a $400 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $40 and $100 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $60.
Ambulance and Transportation Services See details
The HumanaChoice Giveback H5216-322 (PPO) plan covers ambulance services, including both ground and air ambulance services, each with a $315 copay and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services and Urgently Needed Services, are covered. Emergency Services and Worldwide Emergency Coverage have a $100 copay, while Urgently Needed Services has a $45 copay; all services have no coinsurance.
Primary Care See details
The HumanaChoice Giveback H5216-322 (PPO) plan covers primary care physician services and chiropractic services with no copay, and occupational therapy services with a $35 copay. Physician specialist services have a $40 copay, and mental health specialty services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, while additional telehealth benefits have a copay ranging from $0 to $45. Opioid treatment program services have a copay between $40 and $100. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services. Additional preventive services are covered, and the plan also covers Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following a Welcome Visit, all with no copay. However, 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services are partially covered. Hearing exams have a $40 copay, while routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids of all types, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, while routine eye exams are not covered. Eyewear is covered with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the HumanaChoice Giveback H5216-322 (PPO) plan. Medicare Dental Services have a $40 copay, while orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and 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, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Giveback H5216-322 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under HumanaChoice Giveback H5216-322 (PPO). Durable Medical Equipment (DME) has no copay or coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 10% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $325, Therapeutic Radiological Services have a maximum copay of $50 and a minimum coinsurance of 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-322 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice Giveback H5216-322 (PPO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice Giveback H5216-322 (PPO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice Giveback H5216-322 (PPO) plan covers acupuncture with a $40 copay and up to 20 treatments per year, but other services such as Over-the-Counter (OTC) Items and meal benefits are not covered. Additionally, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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