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HumanaChoice Giveback H5216-340 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-340 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-340 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-340 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Iowa and Nebraska. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-340 (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 H5216-340 (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 H5216-340 (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 $64.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $600.00 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 $10100.00 (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 $10100.00 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 H5216-340 (PPO) plan features an annual drug deductible of $600. 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 are also highly affordable, with a low $1 copay for a 1-month supply at standard pharmacies or preferred mail order, and no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply across standard pharmacies and mail order services, though a 3-month supply through preferred mail order reduces the cost to $94. Higher-tier medications require coinsurance instead of copays, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 26% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice Giveback H5216-340 (PPO) plan offers robust healthcare coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $440 for days one through five of acute stays, with no copay for subsequent days. Specialized medical services like specialist visits, emergency care, and urgent care require fixed copays of $45, $130, and $50 respectively, while diagnostic labs and outpatient X-rays are available with no copay. This plan also includes key auxiliary benefits, such as dental coverage up to a $4,000 annual limit with no copay for preventive and restorative care. Routine vision and hearing exams are covered with no copay, though prescription hearing aids require a copay ranging from $699 to $999. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by HumanaChoice Giveback H5216-340 (PPO) with no coinsurance, featuring a $440 daily copay for days 1-5 of acute stays (no copay for days 6 and beyond) and a $370 daily copay for days 1-5 of psychiatric stays (no copay for days 6-90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-340 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services, a $440 copay per stay for observation services, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse sessions also require no coinsurance and have a $0 to $30 copay, though prior authorization is required for most services.
Partial Hospitalization See details
HumanaChoice Giveback H5216-340 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-340 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and coinsurance for ground ambulance services, and a 20% coinsurance and copay for air ambulance services. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Giveback H5216-340 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-340 (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Other services like physical therapy and mental health sessions have copays of $30 to $40 with no coinsurance, while chiropractic benefits are only partially covered as routine chiropractic care is not covered, and podiatry is not covered.
Preventive Services See details
HumanaChoice Giveback H5216-340 (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, post-welcome visit EKGs, and a memory fitness benefit. However, these benefits are only partially covered, as the plan excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling services.
Hearing Services See details
HumanaChoice Giveback H5216-340 (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, excluding inner ear, outer ear, and over the ear types which are not covered. Over-the-counter (OTC) hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice Giveback H5216-340 (PPO) covers vision services with no coinsurance, featuring a $0 to $45 copay for eye exams and no copay for covered eyewear, though prior authorization is required. This partially covered benefit includes one routine exam and one pair of contact lenses or eyeglasses per year up to specified allowance limits, but does not cover other eye exams, separate eyeglass lenses, separate frames, or upgrades.
Dental Services See details
Dental services are partially covered by HumanaChoice Giveback H5216-340 (PPO) up to a $4,000 annual limit, featuring no copay and no coinsurance for preventive, diagnostic, and restorative care, while Medicare-covered dental has a $45 copay and no coinsurance. Removable and fixed prosthodontics require no copay and a 30% coinsurance, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-340 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Giveback H5216-340 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice Giveback H5216-340 (PPO) covers durable medical equipment, 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.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice Giveback H5216-340 (PPO) with no coinsurance, though prior authorization is required. Members pay no copay for lab and outpatient X-ray services, while copays range from $0 to $100 for diagnostic procedures, start at $0 for diagnostic radiological services, and start at $45 for therapeutic radiological services.
Home Health Services See details
Home health services are covered by the HumanaChoice Giveback H5216-340 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice Giveback H5216-340 (PPO) plan, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice Giveback H5216-340 (PPO) with no coinsurance, featuring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by HumanaChoice Giveback H5216-340 (PPO), which features acupuncture for a $45 copay and no coinsurance, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Specific sub-services, including Dual Eligible SNPs with Highly Integrated Services and other unspecified services (Other 1, 2, and 3), are not covered.
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