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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 2026, 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 El Paso and Rio Grande Valley Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $120.00. 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 $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 H5216-350 (PPO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay for one-month or three-month supplies filled at standard pharmacies or through preferred mail order. If you choose standard mail order for these generic tiers, copayments range from $10 to $20 for a one-month supply. For Tier 3 preferred brand drugs, copays start at $30 for a one-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 34% coinsurance and Tier 5 specialty drugs requiring a 33% coinsurance. This structure keeps everyday generic medications highly affordable while sharing costs on brand-name and specialty prescriptions.
Additional Benefits
The HumanaChoice Giveback H5216-350 (PPO) plan offers cost-effective coverage with no copays and no coinsurance for primary care visits, preventive care, routine hearing exams, and home health services. Dental care is highly accessible under this plan, featuring up to a $3,000 annual maximum benefit with no copays or coinsurance for most preventive and comprehensive services. For specialized care, members can expect affordable copays ranging from $25 to $35 with no coinsurance for specialist visits, vision exams, and physical therapies. For emergency and inpatient needs, the plan utilizes predictable copays, including a $115 copay for emergency room visits and a $325 daily copay for the first six days of inpatient hospital stays. Skilled nursing facility stays also feature no copay for the first 20 days, followed by a $218 daily copay. Major medical expenses, such as durable medical equipment and dialysis services, require no copays but do carry a coinsurance ranging from 10% to 20%.
Inpatient Hospital See details
HumanaChoice Giveback H5216-350 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered under the HumanaChoice Giveback H5216-350 (PPO) plan feature no coinsurance, though prior authorization is required. There is no copay for ambulatory surgical center and blood services, while outpatient hospital services have a copay of $0 to $350, outpatient substance abuse sessions have a copay of $30 to $35, and observation services require a $325 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered under the HumanaChoice Giveback H5216-350 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice Giveback H5216-350 (PPO), requiring a $335 copay and no coinsurance for ground ambulance, and a 20% coinsurance with no copay for air ambulance, with prior authorization needed. While some transportation services are covered, trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
HumanaChoice Giveback H5216-350 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-350 (PPO) primary care benefits feature no copay and no coinsurance for primary care visits, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and mental health therapies are covered with copays ranging from $25 to $30 and no coinsurance, but podiatry is not covered and chiropractic care is only partially covered due to the exclusion of other chiropractic services.
Preventive Services See details
HumanaChoice Giveback H5216-350 (PPO) covers preventive services—including annual physical exams, kidney disease education, and diabetes self-management training—with no copay and no coinsurance. Additional preventive services are only partially covered, featuring a memory fitness benefit with no copay or coinsurance, while services like health education, weight management programs, and personal emergency response systems are not covered.
Hearing Services See details
HumanaChoice Giveback H5216-350 (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter (OTC) hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HumanaChoice Giveback H5216-350 (PPO) with no deductibles, no coinsurance, and copays ranging from no copay to $35. Covered benefits include annual routine eye exams and select eyewear up to plan limits, while other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice Giveback H5216-350 (PPO), which provides up to a $3,000 annual maximum benefit with no copay and no coinsurance for most preventive and comprehensive care, though Medicare-covered dental requires a $35 copay and no coinsurance. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-350 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from no coinsurance to 20%, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice Giveback H5216-350 (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HumanaChoice Giveback H5216-350 (PPO) covers durable medical equipment (DME) with a 17% coinsurance and no copay, and prosthetics or medical supplies with a 20% coinsurance and no copay. Diabetic supplies from specified manufacturers are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5216-350 (PPO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic procedures and tests have no coinsurance and a copay ranging from no copay to $175, lab and outpatient X-ray services have no copay, and therapeutic radiological services require a minimum $35 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice Giveback H5216-350 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice Giveback H5216-350 (PPO) covers cardiac rehabilitation services with no copay and no coinsurance, although only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered, and prior authorization is required for any covered services.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-350 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, but does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a daily copay of $218 for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by HumanaChoice Giveback H5216-350 (PPO) include acupuncture, which has a $35 copay and no coinsurance for up to 20 treatments per year. Over-the-counter (OTC) items and meal benefits are also covered with no copay and no coinsurance, though prior authorization is required for acupuncture and meals.
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