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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 2026, 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 2026.
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 $130.00. 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 $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 H5216-345 (PPO) plan features an annual prescription drug deductible of $450. Tier 1 preferred generic drugs are highly affordable, offering no copay for both one-month and three-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs require a low $5 copay for a one-month supply, which drops to no copay for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs have a standard $47 copay for a one-month supply, though you can save with a $131 copay for a three-month supply through preferred mail order. For higher-tier medications, you will pay a 40% coinsurance for Tier 4 non-preferred drugs and a 27% coinsurance for Tier 5 specialty drugs. This Medicare Advantage plan provides structured copays and coinsurance rates to help you manage your healthcare expenses effectively.
Additional Benefits
The HumanaChoice Giveback H5216-345 (PPO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, annual physicals, routine eye exams, and preventive dental care. For specialized medical needs, members will pay a $40 copay for specialist visits, a $360 daily copay for the first seven days of an inpatient hospital stay, and a $115 copay for emergency room visits. Outpatient surgical services and laboratory services are also highly accessible, featuring no copay and no coinsurance. Ancillary benefits include routine hearing exams with no copay and prescription hearing aid copays ranging from $699 to $999. Vision care features a $150 annual allowance for covered eyewear with no copay, and skilled nursing facility stays require no copay for the first 20 days. Additionally, durable medical equipment is covered with a 15% coinsurance and no copay, while home health services are available with no copay and no coinsurance.
Inpatient Hospital See details
HumanaChoice Giveback H5216-345 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $360 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, with no copay for remaining covered days. Hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-345 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a $0 to $450 copay, observation services carry a $360 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice Giveback H5216-345 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-345 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. For transportation, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
HumanaChoice Giveback H5216-345 (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-345 (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits have a $40 copay and no coinsurance. Therapy, mental health, and psychiatric services require copays ranging from $25 to $35 with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Giveback H5216-345 (PPO) provides partial coverage for preventive services, offering annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. However, several additional services are not covered, including fitness benefits, health education, personal emergency response systems, and nutritional counseling.
Hearing Services See details
Hearing services covered by the HumanaChoice Giveback H5216-345 (PPO) include Medicare-covered exams for a $40 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two devices per year, though OTC models and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H5216-345 (PPO) provides partially covered vision services with no coinsurance, including one routine eye exam per year with no copay and other exams with a $0 to $40 copay. Covered eyewear has no copay up to a $150 annual limit for one pair of contact lenses or complete eyeglasses, while individual lenses, frames, upgrades, and other eye exams are not covered.
Dental Services See details
HumanaChoice Giveback H5216-345 (PPO) offers partially covered dental services with a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive and comprehensive care. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice Giveback H5216-345 (PPO) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, insulin, and other drugs are covered with no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice Giveback H5216-345 (PPO) plan with no copay and a 20% coinsurance, with prior authorization required.
Medical Equipment See details
HumanaChoice Giveback H5216-345 (PPO) covers durable medical equipment (DME) with a 15% coinsurance and no copay, and prosthetic devices 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
HumanaChoice Giveback H5216-345 (PPO) covers diagnostic and radiological services with prior authorization required, offering lab services and outpatient X-rays with no copay. Diagnostic tests range from a $0 to $120 copay with no coinsurance, while therapeutic radiological services require a copay starting at $40 and a minimum 20% coinsurance.
Home Health Services See details
HumanaChoice Giveback H5216-345 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice Giveback H5216-345 (PPO) plan, which includes no coverage for intensive cardiac rehabilitation, pulmonary rehabilitation, or supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice Giveback H5216-345 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Giveback H5216-345 (PPO) provides partial coverage for other services, including acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Both covered services require prior authorization, while over-the-counter (OTC) items are not covered under this benefit.
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