A non-government entity
HumanaChoice Giveback H5216-350 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-350 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-350 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-350 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-350 (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 H5216-350 (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 H5216-350 (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 $116.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13300.00 (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 $13300.00 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:
Sign up for HumanaChoice Giveback H5216-350 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice Giveback H5216-350 (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay varying copays and coinsurance amounts depending on the drug tier and pharmacy type. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The HumanaChoice Giveback H5216-350 (PPO) plan offers a range of benefits, including inpatient and outpatient hospital care with varying copays. You'll find no copays for primary care visits, preventive services like annual physicals, routine hearing exams, vision services, and dental services. The plan also covers services such as ambulance, emergency, and home health services. Additional benefits include coverage for hearing aids, vision, and dental services. Diagnostic and radiological services are covered, along with home infusion, dialysis, and medical equipment. This plan also includes coverage for acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $325 for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute have no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
The HumanaChoice Giveback H5216-350 (PPO) plan covers outpatient hospital services with a copay between $0 and $350, observation services with a $325 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay between $30 and $100 for both individual and group sessions, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by HumanaChoice Giveback H5216-350 (PPO) with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance. Ground ambulance services have a copay of $315, while air ambulance services have a 20% 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 by the HumanaChoice Giveback H5216-350 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay, and all services have no coinsurance.
Primary Care See details
The HumanaChoice Giveback H5216-350 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a $55 copay, mental health specialty services with a $30 copay, physical therapy and speech-language pathology services with a $25 copay, and additional telehealth benefits with a copay ranging from $0 to $55. The plan does not cover podiatry services, and routine chiropractic care.
Preventive Services See details
The HumanaChoice Giveback H5216-350 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, and some services have a copay. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. However, health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
The HumanaChoice Giveback H5216-350 (PPO) plan covers hearing exams with a $55 copay, routine hearing exams with no copay for one exam per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $699 and $999 for all types of prescription hearing aids (2 per year), but hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered up to $40 every three months.
Vision Services See details
The HumanaChoice Giveback H5216-350 (PPO) plan covers vision services, including routine eye exams with a copay of $0 - $55, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5216-350 (PPO) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleanings, and other preventative services, with no copay. Orthodontic services are also covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. However, fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs, and a coinsurance between 0% and 20% for all Part B drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-350 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the HumanaChoice Giveback H5216-350 (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $175, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325. Therapeutic Radiological Services have a maximum copay of $40 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 H5216-350 (PPO) plan with no copay and no coinsurance; however, Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the services: 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. A copay applies, and prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Giveback H5216-350 (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The HumanaChoice Giveback H5216-350 (PPO) plan covers acupuncture with a $55 copay and a limit of 20 treatments per year, as well as over-the-counter items with a $40 maximum benefit every three months. This plan also provides a meal benefit with no copay. Additional services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved