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HumanaChoice Giveback H5216-328 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-328 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-328 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-328 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-328 (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 H5216-328 (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 H5216-328 (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 $119.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $460.00 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 H5216-328 (PPO) plan has a $590 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, Tier 1 drugs have a $10 copay at a standard pharmacy, while Tier 3 drugs have 45% coinsurance. Once your total drug costs reach $2,000, you enter the Catastrophic Coverage Phase and pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The HumanaChoice Giveback H5216-328 (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including blood services, often have no copay. Emergency and urgently needed services have copays, and ambulance services have a copay. Preventive services, including an annual physical exam, have no copay. The plan also covers vision services, with eye exams costing between $0 and $45, and eyewear with no copay. Dental services are partially covered. Medical equipment, diagnostic services, and home health services have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric hospital stays. For acute stays, you'll pay a $400 copay for days 1-5, and no copay for days 6-90, while additional days 91-999 have no copay; psychiatric stays have a $400 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services are covered by the HumanaChoice Giveback H5216-328 (PPO) plan, including all outpatient hospital services, with a copay of $0-$400, observation services with a $400 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services with a copay of $40-$100 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by HumanaChoice Giveback H5216-328 (PPO) with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice Giveback H5216-328 (PPO). Ground and Air Ambulance Services have a $315 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services include a $100 copay, while Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $100 copay, and no coinsurance.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services and Chiropractic Services, and a $20-$35 copay for Occupational Therapy Services. Physician Specialist Services have a $45 copay, while Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40-$100 copay. Physical Therapy and Speech-Language Pathology Services have a $20-$35 copay, and Additional Telehealth Benefits have a $0-$45 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice Giveback H5216-328 (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing Services are partially covered by the HumanaChoice Giveback H5216-328 (PPO) plan. Hearing Exams have a $45 copay, but Routine Hearing Exams and Fitting/Evaluation for Hearing Aid are not covered, and Prescription Hearing Aids (all types), Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are also not covered.
Vision Services See details
Vision services are covered, with eye exams costing between $0 and $45. 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 by the HumanaChoice Giveback H5216-328 (PPO) plan, with a $45 copay for Medicare Dental Services. 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 under the HumanaChoice Giveback H5216-328 (PPO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-328 (PPO) plan, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
The HumanaChoice Giveback H5216-328 (PPO) plan covers medical equipment, including Durable Medical Equipment (DME) with no copay and no coinsurance, and Prosthetics/Medical Supplies with no copay and 9% coinsurance for Medicare-covered services. The plan also covers Diabetic Equipment with a 10-20% coinsurance for Diabetic Supplies and a $10 copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HumanaChoice Giveback H5216-328 (PPO) plan. Diagnostic Procedures/Tests have a maximum copay of $100, and Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have a maximum copay of $50 and a minimum coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-328 (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 covered, but none of the sub-services are covered, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Giveback H5216-328 (PPO) plan, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The HumanaChoice Giveback H5216-328 (PPO) plan covers acupuncture with a $45 copay, but it is limited to 20 treatments per year and requires prior authorization. Other services, including over-the-counter items, meal benefits, and many others, are not covered.
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