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HumanaChoice Giveback H5216-371 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-371 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-371 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-371 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Maricopa Pima Pinal. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-371 (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 H5216-371 (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 H5216-371 (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 $90.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $400.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 $9750.00 (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 $9750.00 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 H5216-371 (PPO) plan features an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay a $4.00 copay for preferred generics at standard pharmacies and preferred mail, or a $47.00 copay for standard generics. Preferred brand drugs require a 47% coinsurance, while non-preferred drugs carry a 25% coinsurance during the initial coverage phase. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, individuals who qualify for the low-income subsidy can reduce their Part D premium to no cost.
Additional Benefits
The HumanaChoice Giveback H5216-371 (PPO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits, home health services, and routine annual physical exams. For emergency medical needs, there is a $130 copay with no coinsurance, while inpatient hospital stays require a daily copay of $375 for acute care or $322 for psychiatric care during the first six days. Outpatient hospital services range from no copay up to a $375 copay, with lab and outpatient X-ray services requiring no copay or coinsurance. This plan also includes key ancillary benefits, offering no copay for routine vision exams, routine hearing evaluations, and most preventive dental services up to a $1,000 annual limit. Medical equipment, including durable medical equipment and diabetic supplies, is covered with coinsurance ranging from 10% to 15% and no copay. Additionally, skilled nursing facility stays are covered with no coinsurance, requiring a $10 daily copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by HumanaChoice Giveback H5216-371 (PPO), featuring no coinsurance for covered stays. Acute care requires a $375 daily copay for days 1 through 6 (no copay for days 7 through 999), while psychiatric stays require a $322 daily copay for days 1 through 6 (no copay for days 7 through 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice Giveback H5216-371 (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $375, observation services require a $375 copay per stay, and outpatient substance abuse sessions have a $25 to $35 copay.
Partial Hospitalization See details
HumanaChoice Giveback H5216-371 (PPO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HumanaChoice Giveback H5216-371 (PPO), as routine transportation services to health-related locations are not covered. Covered ground ambulance services require a $320 copay and no coinsurance, while air ambulance services require a $630 copay and no coinsurance.
Emergency Services See details
HumanaChoice Giveback H5216-371 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay 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 at a $130 copay with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by HumanaChoice Giveback H5216-371 (PPO), featuring no copay and no coinsurance for primary care physician visits. Other covered services like specialist visits, therapy, and mental health sessions require copays ranging from $0 to $50 with no coinsurance, while podiatry services and routine chiropractic care are not covered.
Preventive Services See details
HumanaChoice Giveback H5216-371 (PPO) partially covers preventive services with no copay and no coinsurance for annual physical exams, memory fitness, and kidney disease education. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, remote technologies, home modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice Giveback H5216-371 (PPO) provides partially covered hearing services with no deductibles or coinsurance, featuring a $35 copay for Medicare-covered exams and no copay for routine exams and evaluations. Up to two prescription hearing aids are covered annually with a $399 to $699 copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice Giveback H5216-371 (PPO) partially covers vision services, offering routine eye exams, contact lenses, and eyeglasses with no copay and no coinsurance, while other eye exams require a copay of up to $35 with no coinsurance. Eyeglass lenses, eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
HumanaChoice Giveback H5216-371 (PPO) partially covers dental services up to a $1,000 annual limit, offering most preventive and comprehensive services with no copay and no coinsurance. Medicare-covered dental services require a $35 copay and no coinsurance, while fixed and removable prosthodontics require a 30% coinsurance and no copay. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-371 (PPO) covers home infusion bundled services with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for Medicare Part B insulin. Chemotherapy, radiation, and other Part B drugs are also covered with no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Giveback H5216-371 (PPO) plan with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice Giveback H5216-371 (PPO) covers medical equipment, including durable medical equipment (DME) and medical supplies at a 15% coinsurance with no copay. Prosthetic devices require a 20% coinsurance with no copay, while diabetic supplies carry a 10% to 20% coinsurance with no copay, and diabetic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5216-371 (PPO) covers diagnostic and radiological services, with prior authorization required. Diagnostic tests require a $0 to $50 copay and 20% coinsurance, therapeutic radiology incurs a $75 copay and 20% coinsurance, diagnostic radiology has a copay of up to $300, and lab and outpatient X-ray services have no copay or coinsurance.
Home Health Services See details
Home Health Services are covered under the HumanaChoice Giveback H5216-371 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice Giveback H5216-371 (PPO) plan, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-371 (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Giveback H5216-371 (PPO) partially covers other services, offering acupuncture with a $35 copay and no coinsurance, and meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items and Dual Eligible SNPs with highly integrated services are not covered under this plan.
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