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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 2026, 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 2026.
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 $590.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $325.00 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 H5216-328 (PPO) Medicare plan features an annual prescription drug deductible of $325. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $1 copay for a 1-month supply at standard pharmacies, with no copay required for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $30 copay for a 1-month supply at standard pharmacies and preferred mail order. Higher-tier prescriptions involve coinsurance instead of flat copays, with Tier 4 non-preferred drugs requiring a 45% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice Giveback H5216-328 (PPO) plan offers affordable coverage for your essential medical needs, featuring no copay or coinsurance for primary care doctor visits and annual physicals. Specialist visits require a $45 copay, while emergency room visits are covered with a $115 copay that is waived upon hospital admission. If you require inpatient hospital care, you will pay a $400 daily copay for the first five days, followed by no copay for additional days. This plan also includes routine dental, vision, and hearing benefits to keep your out-of-pocket expenses low. You will enjoy no copay or coinsurance for routine hearing exams, routine eye exams, and preventive dental care up to a $1,500 annual limit. Additionally, home health services are available with no copay, and durable medical equipment is covered with a 15% coinsurance.
Inpatient Hospital See details
HumanaChoice Giveback H5216-328 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization. Acute stays require a $400 daily copay for days 1 to 5 (and no copay for days 6 and beyond), while psychiatric stays require a $400 daily copay for days 1 to 4 (and no copay for days 5 to 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-328 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $35 copay for substance abuse sessions. Outpatient hospital services require a copay ranging from $0 to $400, while observation services have a $400 copay per stay, with prior authorization required for most services.
Partial Hospitalization See details
HumanaChoice Giveback H5216-328 (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 H5216-328 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. However, transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Giveback H5216-328 (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 emergency transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-328 (PPO) offers primary care physician visits with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Therapy, mental health, and telehealth services have copays ranging from $0 to $45 with no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
HumanaChoice Giveback H5216-328 (PPO) offers partially covered preventive services, providing annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit with no copay and no coinsurance. However, several supplemental preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services under the HumanaChoice Giveback H5216-328 (PPO) plan are covered with no deductible and no coinsurance, featuring a $45 copay for Medicare-covered exams and no copay for routine annual exams or fitting evaluations. Prescription hearing aids are partially covered with a copay of $499 to $799 for up to two devices per year, though OTC hearing aids and inner, outer, or over-the-ear prescription types are not covered.
Vision Services See details
HumanaChoice Giveback H5216-328 (PPO) provides partially covered vision services with no coinsurance, featuring a $0 to $45 copay for eye exams and no copay for covered eyewear under a $300 annual limit. One routine eye exam, one pair of contact lenses, and one pair of eyeglasses (lenses and frames) are covered yearly, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice Giveback H5216-328 (PPO) up to a $1,500 annual limit, offering no copay and no coinsurance for preventive care and most comprehensive treatments, while Medicare-covered dental requires a $45 copay (no coinsurance) and fixed prosthodontics require a 30% coinsurance (no copay). Fluoride, implants, orthodontics, maxillofacial prosthetics, and removable prosthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-328 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, carry between no coinsurance and 20% coinsurance, while Medicare Part B insulin has a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HumanaChoice Giveback H5216-328 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice Giveback H5216-328 (PPO) covers durable medical equipment (DME) with a 15% coinsurance and no copay, and prosthetics and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5216-328 (PPO) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic procedures with a $0 to $100 copay, with prior authorization required. Radiological services are also covered with prior authorization, featuring no copay for outpatient X-rays, starting at no copay for diagnostic radiological services, and requiring a minimum $50 copay and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the HumanaChoice Giveback H5216-328 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice Giveback H5216-328 (PPO) does not cover Cardiac Rehabilitation Services in practice, as sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are all not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-328 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior inpatient hospital stay is not required for admission, additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by HumanaChoice Giveback H5216-328 (PPO), which offers acupuncture for a $45 copay and no coinsurance for up to 20 treatments per year, as well as a meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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