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Humana Full Access Giveback H5216-393 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access Giveback H5216-393 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access Giveback H5216-393 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access Giveback H5216-393 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Central and North Florida. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Full Access Giveback H5216-393 (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 Humana Full Access Giveback H5216-393 (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 Humana Full Access Giveback H5216-393 (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 $174.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $275.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $6700.00 (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 $6700.00 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 Humana Full Access Giveback H5216-393 (PPO) plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will have no copay for preferred generic drugs at a standard pharmacy. However, you will pay 33% coinsurance for preferred brand drugs.
Additional Benefits
The Humana Full Access Giveback H5216-393 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays of $350, while outpatient services have copays that vary. Primary care visits have no copay, and many preventive services, like an annual physical, are also covered with no copay. The plan includes coverage for hearing, vision, and dental services, with copays and no coinsurance for many services. Emergency services have a $125 copay, and ambulance services have copays between $190 and $240. Additionally, the plan covers home health services, skilled nursing facility stays, and other services like acupuncture, often with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-7 and no copay for days 8-90, with no coinsurance; for Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5 and no copay for days 6-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute are covered with no copay and no coinsurance for days 91-999. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $295, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $30 and $100, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $45 copay and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Full Access Giveback H5216-393 (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a copay of $190-$240, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Full Access Giveback H5216-393 (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $15 copay and no coinsurance, and Worldwide Emergency Services have a $125 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Full Access Giveback H5216-393 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $40 copay. Physician specialist services have a $45 copay, and mental health specialty services have a $30 copay for individual or group sessions. Other health care professionals may have a copay between $0 and $45, and psychiatric services individual and group sessions both have a $30 copay. Physical therapy and speech-language pathology services have a $40 copay. The plan also covers additional telehealth benefits with a copay between $0 and $45 and opioid treatment program services with a copay between $30 and $100.
Preventive Services See details
The Humana Full Access Giveback H5216-393 (PPO) plan covers preventive services, including an annual physical exam with no copay. Other services like Health Education, In-Home Safety Assessment, and others are not covered, while services like Glaucoma Screening, Diabetes Self-Management Training, and others have no copay.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $500 per ear annually, and OTC hearing aids are covered with no copay and a maximum benefit of $500 per ear annually. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $45, and eyewear with no copay. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Full Access Giveback H5216-393 (PPO) plan covers dental services, including oral exams with no coinsurance, dental x-rays with no coinsurance, other diagnostic dental services with no coinsurance, prophylaxis (cleaning) with no coinsurance, restorative services with a $25 copay, and adjunctive general services with no coinsurance. Fluoride treatment, endodontics, prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. There is a $1,000 maximum plan benefit coverage amount per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization, and the coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and 3% coinsurance, Prosthetic Devices and Medical Supplies have 20% coinsurance, and Diabetic Supplies have no copay and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a coinsurance of at most 20% and a maximum copay of $150, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $295, Therapeutic Radiological Services have a coinsurance of at most 20% and a maximum copay of $45, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Full Access Giveback H5216-393 (PPO) plan with no copay and no coinsurance, but 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 none of the sub-services are covered by this plan. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Full Access Giveback H5216-393 (PPO) plan, with a $0 copay for days 1-20, and a $160 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 "Humana Full Access Giveback H5216-393 (PPO)" plan covers acupuncture with no copay and a limit of 25 treatments per year, 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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