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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 2026, 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 2026.
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 $170.00. 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 $600.00 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 $6750.00 (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 $6750.00 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 an annual prescription drug deductible of $600. For Tier 1 preferred generics, there is no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs carry a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, and there is no copay for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs cost a $47 copay for a 1-month supply, while a 3-month supply costs $94 through preferred mail order and $141 at standard pharmacies. Tier 4 non-preferred drugs require a 49% coinsurance for both 1-month and 3-month supplies. Specialty drugs in Tier 5 carry a 26% coinsurance for a 1-month supply across all standard pharmacy and mail order options.
Additional Benefits
The Humana Full Access Giveback H5216-393 (PPO) plan offers coverage for essential medical care with no copay and no coinsurance for primary care visits and preventive services. Specialist visits require a $45 copay, while inpatient hospital stays require a $400 daily copay for the first several days before transitioning to no copay. Emergency room visits have a $130 copay, which is waived if you are admitted, and outpatient hospital services range from no copay up to a $295 copay. Routine dental, vision, and hearing exams are covered with no copay, though annual limits apply, such as a $1,000 maximum for dental services and up to $500 per ear for prescription hearing aids. Home health care features no copay and no coinsurance, while medical equipment and dialysis services require coinsurance ranging from 15% to 20% with no copay. This plan does not cover cardiac rehabilitation or over-the-counter items, making it essential to review specific benefit exclusions when planning your care.
Inpatient Hospital See details
Humana Full Access Giveback H5216-393 (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, you pay a $400 daily copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric stays require a $400 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Full Access Giveback H5216-393 (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $295 for outpatient hospital services and $400 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have no coinsurance and a $30 to $35 copay.
Partial Hospitalization See details
Humana Full Access Giveback H5216-393 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Full Access Giveback H5216-393 (PPO) partially covers ambulance and transportation services, requiring prior authorization for all ambulance transfers. Ground ambulance services require a copay of $190.00 to $240.00 and coinsurance, while air ambulance services require a 20% coinsurance and a copay. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Humana Full Access Giveback H5216-393 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are available with a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Full Access Giveback H5216-393 (PPO) covers primary care physician services and select telehealth benefits with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Other services like physical, occupational, and speech therapy, mental health, and podiatry require copays ranging from $30 to $45 with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Humana Full Access Giveback H5216-393 (PPO) partially covers preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, and memory fitness benefits. However, several supplemental services are not covered under this plan, such as health education, in-home safety assessments, personal emergency response systems (PERS), and weight management programs.
Hearing Services See details
Humana Full Access Giveback H5216-393 (PPO) partially covers hearing services, offering Medicare-covered exams for a $45 copay and no coinsurance, while routine exams, fittings, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by the Humana Full Access Giveback H5216-393 (PPO) plan, which features no copays, no coinsurance, and no deductibles for routine care. The plan covers one routine eye exam per year up to $75 and one pair of contact lenses or eyeglasses (lenses and frames) up to a combined $100 annual limit, while other eye exams, separate lenses or frames, and upgrades are not covered.
Dental Services See details
Humana Full Access Giveback H5216-393 (PPO) dental services are partially covered up to a $1,000 annual maximum limit. Medicare-covered dental has a $45 copay and no coinsurance, preventive care has no copay and no coinsurance, and restorative services require a $25 copay and no coinsurance. Fluoride, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Full Access Giveback H5216-393 (PPO) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and other drugs, carry a coinsurance ranging from 0% to 20%, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Humana Full Access Giveback H5216-393 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Full Access Giveback H5216-393 (PPO) covers medical equipment, including durable medical equipment (DME) and medical supplies at a 15% coinsurance with no copay. Prosthetic devices and diabetic supplies are covered with a 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $5 copay and no coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Full Access Giveback H5216-393 (PPO) covers diagnostic and radiological services with prior authorization, featuring no copay for lab services, outpatient X-rays, and diagnostic radiological services. Diagnostic procedures and tests carry a copay of $0 to $150, while therapeutic radiological services have a $45 copay. Coinsurance of 20% applies to diagnostic procedures and therapeutic radiological services, and coinsurance is also required for lab and X-ray services.
Home Health Services See details
Home Health Services are covered under the Humana Full Access Giveback H5216-393 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Full Access Giveback H5216-393 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Full Access Giveback H5216-393 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $160 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not needed, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Humana Full Access Giveback H5216-393 (PPO) partially covers other services, providing acupuncture for up to 25 treatments per year and a limited-duration meal benefit with no copay and no coinsurance, though prior authorization is required. Over-the-counter (OTC) items and other supplemental services are not covered under this plan.
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