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HumanaChoice Giveback H5216-345 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-345 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-345 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-345 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Georgia and South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-345 (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 H5216-345 (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 H5216-345 (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 $105.00. 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 $450.00 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 H5216-345 (PPO) plan has a $450 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For the initial coverage phase, you will pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy, while standard generic drugs have a $47 copay. Preferred and non-preferred brand drugs have a 38% and 27% coinsurance, respectively. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HumanaChoice Giveback H5216-345 (PPO) plan offers a range of benefits with varying costs. You'll find no copay for primary care visits, annual physical exams, and many preventive and dental services. However, you can expect copays for specialist visits, outpatient services, and emergency services, which range from $15 to $375 depending on the service. This plan includes coverage for inpatient and outpatient hospital stays, with copays applicable for certain services. Home health services and skilled nursing facilities also have coverage, with no copay for home health and a copay for SNF stays after the first 20 days. Additionally, the plan covers hearing, vision, and dental services with some limitations, along with ambulance, diagnostic, and therapeutic services at varying costs.
Inpatient Hospital See details
Inpatient Hospital benefits include acute and psychiatric care, with a copay of $375 per admission for days 1-5, and no copay for days 6-90, while additional days for acute care have no copay. Non-Medicare-covered stays and upgrades for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care are not covered.
Outpatient Services See details
The HumanaChoice Giveback H5216-345 (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $450, observation services with a $375 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $45 and $100 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan. You will pay a copay of $80.00 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HumanaChoice Giveback H5216-345 (PPO) plan. Both 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, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay; there is no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice Giveback H5216-345 (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, while occupational therapy services have a $25 copay. Physician specialist services have a $45 copay, and mental health specialty services have a $45 copay for both individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $45, and Opioid Treatment Program Services have a copay between $45 and $100.
Preventive Services See details
The HumanaChoice Giveback H5216-345 (PPO) plan covers preventive services including an annual physical exam with no copay, and Kidney Disease Education Services with no copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and other additional preventive services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice Giveback H5216-345 (PPO) plan covers vision services, including eye exams with a copay of $0-$45. Eyewear is covered with no copay, and contact lenses and eyeglasses (lenses and frames) are covered with no copay. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5216-345 (PPO) plan covers Medicare Dental Services with a $45 copay, and covers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services with no copay. Fluoride Treatment, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered. Adjunctive General Services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-345 (PPO) plan and require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
The HumanaChoice Giveback H5216-345 (PPO) plan covers Durable Medical Equipment (DME) with a 4% coinsurance and requires authorization. Prosthetics and medical supplies have no copay, but require a coinsurance for some services, with 15% for medical supplies and 15% for prosthetic devices. Diabetic equipment is covered, with a coinsurance of 10-20% for diabetic supplies and a copay of $10 for diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HumanaChoice Giveback H5216-345 (PPO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $120, while Lab Services have no copay; Diagnostic Radiological Services have a maximum copay of $325, Therapeutic Radiological Services have a maximum copay of $45 and a minimum coinsurance of 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice Giveback H5216-345 (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. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the HumanaChoice Giveback H5216-345 (PPO) plan, with no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice Giveback H5216-345 (PPO) plan covers acupuncture with a $45 copay, and a meal benefit with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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