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HumanaChoice Giveback H5216-404 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-404 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-404 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-404 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-404 (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 H5216-404 (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 H5216-404 (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 $71.00. 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 $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 $10100.00 (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 $10100.00 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 H5216-404 (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with no copay for a 3-month supply through preferred mail order and a low $10 copay for a 1-month supply at standard pharmacies. For Tier 3 preferred brand drugs, copays start at $47 for a 1-month supply across standard pharmacies and mail-order options. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 48% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. These structured costs help you easily estimate your out-of-pocket prescription expenses under this Humana Choice Giveback PPO plan.
Additional Benefits
The HumanaChoice Giveback H5216-404 (PPO) plan offers affordable coverage with no copay or coinsurance for primary care doctor visits and covered preventive services. Specialist visits, physical therapy, and Medicare-covered dental or hearing exams require a $45 copay, while emergency room visits have a $130 copay. For hospital stays, members pay a $450 daily copay for the first five days of inpatient care and no copay for days six through ninety, with no coinsurance. This plan also features generous supplemental benefits, including dental coverage up to an annual limit of $4,000 with no copay or coinsurance for most preventive and comprehensive care. Routine vision and hearing exams are also covered with no copay, and prescription hearing aids are available with copays ranging from $199 to $799. For specialized medical needs, home health services require no copay, while durable medical equipment and dialysis services are covered with a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice Giveback H5216-404 (PPO) covers inpatient hospital stays with no coinsurance, requiring a $450 daily copay for days 1 through 5 and no copay for days 6 through 90. While acute care includes unlimited additional days with no copay, this benefit is partially covered as psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-404 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $450 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice Giveback H5216-404 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance services are covered by HumanaChoice Giveback H5216-404 (PPO) with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
HumanaChoice Giveback H5216-404 (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 are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5216-404 (PPO) provides primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $45 copay and no coinsurance. Mental health and psychiatric sessions have a $30 copay and no coinsurance, telehealth ranges from no copay to $50 with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under the HumanaChoice Giveback H5216-404 (PPO) plan, offering no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, EKGs, and a memory fitness benefit. Sub-services not covered under this plan include health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
HumanaChoice Giveback H5216-404 (PPO) hearing services include routine exams, fitting evaluations, and OTC hearing aids for no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $199 to $799 and no coinsurance, but inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice Giveback H5216-404 (PPO) with no coinsurance and copays ranging from no copay up to $45. Routine eye exams and select eyewear (contacts or eyeglasses) are covered with no copay up to annual plan limits, while other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice Giveback H5216-404 (PPO) up to an annual maximum of $4,000, featuring no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $45 copay with no coinsurance, prosthodontics require a 30% coinsurance with no copay, and fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-404 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice Giveback H5216-404 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice Giveback H5216-404 (PPO) covers durable medical equipment and prosthetic devices with a 20% coinsurance and no copay, and medical supplies with a 7% coinsurance and no copay. Diabetic supplies 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
Diagnostic and radiological services are covered by HumanaChoice Giveback H5216-404 (PPO), with diagnostic procedures requiring a 20% coinsurance and a $0 to $50 copay, and lab services requiring coinsurance with no copay. Radiological services feature no coinsurance, requiring a $30 copay for therapeutic radiology and no copay for diagnostic radiology and outpatient X-rays.
Home Health Services See details
Home health services are covered under the HumanaChoice Giveback H5216-404 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice Giveback H5216-404 (PPO) covers cardiac rehabilitation services with no coinsurance, though prior authorization is required. Patients are responsible for a $40 copay for cardiac and intensive cardiac rehabilitation, a $20 copay for pulmonary rehabilitation, and a $10 copay for supervised exercise therapy for symptomatic peripheral artery disease.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-404 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 copayment for days 1 to 20 and a $218 copayment for days 21 to 100. Prior authorization is required, and the benefit is partially covered since additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Giveback H5216-404 (PPO) covers acupuncture with a $45 copay and no coinsurance, alongside over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and other supplemental services in this category are not covered.
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