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HumanaChoice Giveback H5216-405 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-405 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-405 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-405 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Kansas City, MO-KS. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-405 (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 H5216-405 (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 H5216-405 (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 $70.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $600.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $250.00 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 H5216-405 (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For tier 1 drugs, you will pay a $10 copay at preferred pharmacies and preferred mail order, and a $20 copay at standard mail order. For tier 2 drugs, you will pay a $47 copay at standard pharmacies and mail order. For tier 3 and 4 drugs, you will pay coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your drugs.
Additional Benefits
The HumanaChoice Giveback H5216-405 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays depending on the length of stay, while outpatient services have copays between $0 and $400. Emergency services, primary care visits, preventive services, and many vision services are covered with no copay. The plan also includes coverage for hearing exams, dental services, and home health services. Dialysis, medical equipment, and diagnostic services are covered with coinsurance and copays. Additionally, this plan covers acupuncture, over-the-counter items, and a meal benefit, all with copays or no copays.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $445 copay for days 1-6, and no copay for days 7-90, and additional days 91-999 have no copay. Inpatient Hospital Psychiatric services have a $380 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $400, observation services with a $445 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual sessions with a copay between $40 and $45, and group sessions with a copay between $40 and $45. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice Giveback H5216-405 (PPO) plan. You will pay a $40 copay for this service, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services and Urgently Needed Services, are covered by this plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $55 copay, and there is no coinsurance for any of these services.
Primary Care See details
The HumanaChoice Giveback H5216-405 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $45 copay, and mental health specialty services with a minimum copay of $45. This plan also covers physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a minimum copay of $40. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, an annual physical exam with no copay, and additional preventive services with a copay. Kidney Disease Education Services and other preventive services, like Glaucoma Screening, also have no copay.
Hearing Services See details
HumanaChoice Giveback H5216-405 (PPO) covers hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered up to $50 every three months.
Vision Services See details
The HumanaChoice Giveback H5216-405 (PPO) plan covers vision services, including eye exams with a copay ranging from $0 to $45 per visit, and eyewear with no copay. Eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services with a $45 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed) and oral and maxillofacial surgery. However, fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered. Prosthodontics (removable and fixed) have a 30% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-405 (PPO) plan, and require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered under the HumanaChoice Giveback H5216-405 (PPO) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay and a coinsurance of 1%. Prosthetic Devices have a 20% coinsurance. Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay and a coinsurance between 10% and 20%, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay up to $55 and at least 20% coinsurance, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $450, Therapeutic Radiological Services with a copay up to $40, and Outpatient X-Ray Services with no copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-405 (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 not the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required, and there is a copay for some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $203; there is no coinsurance. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice Giveback H5216-405 (PPO) plan covers acupuncture with a $45 copay, up to 20 treatments per year, as well as over-the-counter items, with a maximum benefit of $50 every three months. The plan also covers a meal benefit with no copay. Other services such as Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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