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HumanaChoice Giveback H5216-409 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-409 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-409 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-409 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Kansas. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-409 (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 H5216-409 (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 H5216-409 (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 H5216-409 (PPO) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard retail pharmacies and through preferred mail order. Tier 2 generic drugs are available with a $10 copay for a 1-month supply at standard pharmacies, or with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with 3-month savings available through preferred mail order for $131. For higher-tier medications, Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice Giveback H5216-409 (PPO) plan provides comprehensive medical coverage, featuring primary care physician visits, telehealth, and covered preventive services with no copay and no coinsurance. For inpatient hospital stays, members pay a $450 copay for days 1 through 5 and no copay for days 6 through 90, with no coinsurance. Emergency care carries a $130 copay, which is waived upon admission, while urgent care visits require a $50 copay. In addition to medical care, the plan offers generous dental benefits with a $5,000 annual limit and no copay for most preventive and comprehensive services. Routine vision and hearing exams are available with no copay, and members receive allowances for eyewear and coverage for prescription hearing aids. Home health services, lab tests, and over-the-counter items are also covered with no copay, while durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice Giveback H5216-409 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $450 copay for days 1 to 5 and no copay for days 6 to 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-409 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services, a $450 copay per stay for observation services, and a $30 to $35 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, with prior authorization required for most services.
Partial Hospitalization See details
HumanaChoice Giveback H5216-409 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-409 (PPO) covers ground ambulance services with a $335 copay and applicable coinsurance, and air ambulance services with a 20% coinsurance and applicable copay, both requiring prior authorization. Transportation services, including rides to plan-approved or any health-related locations, are not covered.
Emergency Services See details
Emergency services under the HumanaChoice Giveback H5216-409 (PPO) are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care is available for a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits under the HumanaChoice Giveback H5216-409 (PPO) plan are highlighted by primary care physician visits and telehealth services with no copay and no coinsurance. Specialist visits, physical therapy, and occupational therapy require a $45 copay and no coinsurance, while mental health and psychiatric services have a $30 copay and no coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by HumanaChoice Giveback H5216-409 (PPO) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs. Specific sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, 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 counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice Giveback H5216-409 (PPO) covers hearing services, including Medicare-covered exams for a $45 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered—excluding inner ear, outer ear, and over the ear models—with a copay of $199 to $799 and no coinsurance for up to two devices per year, while OTC hearing aids are available with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HumanaChoice Giveback H5216-409 (PPO), offering no copay and no coinsurance for one routine eye exam (up to $75 yearly) and eyewear like contact lenses or complete eyeglasses (up to $200 yearly). Prior authorization is required for these benefits, and other eye exams, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5216-409 (PPO) offers partially covered dental services with a $5,000 annual maximum, featuring no copays and no coinsurance for most preventive and comprehensive care, a $45 copay with no coinsurance for Medicare-covered services, and a 30% coinsurance with no copay for prosthodontics. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-409 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice Giveback H5216-409 (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice Giveback H5216-409 (PPO), featuring a 20% coinsurance and no copay for durable medical equipment (DME) and prosthetics, and a 15% coinsurance and no copay for medical supplies. Diabetic supplies require a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts carry a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5216-409 (PPO) covers diagnostic procedures and tests with a 20% coinsurance and a copay ranging from no copay up to $50, while lab services and outpatient X-rays are covered with no copay. Diagnostic radiological services feature no copay and no coinsurance, while therapeutic radiological services require a $30 copay and no coinsurance.
Home Health Services See details
HumanaChoice Giveback H5216-409 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the HumanaChoice Giveback H5216-409 (PPO) plan, though some services are covered while cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($10 copay) are not covered. Prior authorization is required for these rehabilitation services.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-409 (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice Giveback H5216-409 (PPO) covers acupuncture with a $45 copay and no coinsurance for up to 20 treatments per year, with prior authorization required. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, though some other miscellaneous services are not covered.
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