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Humana Direct Choice Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Direct Choice Giveback (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Direct Choice Giveback (PPO) in 2026, please refer to our full plan details page.
Humana Direct Choice Giveback (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Massachusetts. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Direct Choice Giveback (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 Direct Choice Giveback (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 Direct Choice Giveback (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 $60.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $475.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $395.00 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 $7750.00 (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 $7750.00 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 Direct Choice Giveback (PPO) plan features an annual drug deductible of $395. 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, costing as little as a $1 copay for a 1-month supply, or 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 savings available on 3-month supplies through preferred mail order at $131. For higher-tier medications, Tier 4 non-preferred drugs carry a 48% coinsurance, while Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply across all available pharmacy options.
Additional Benefits
The Humana Direct Choice Giveback (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and home health care. Specialist visits and therapies require a $40 copay, while emergency room visits carry a $130 copay, both with no coinsurance. For inpatient hospital stays, members pay a daily copay of $445 for days 1 through 6 of acute stays, followed by no copay for the remaining covered days. This plan also includes valuable supplemental benefits, such as routine dental coverage up to a $4,000 annual maximum and routine vision and hearing exams with no copays. Prescription hearing aids require a copay ranging from $699 to $999 each. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Direct Choice Giveback (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $445 daily copay for days 1-6 of acute stays and a $380 daily copay for days 1-6 of psychiatric stays, followed by no copay for remaining covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Humana Direct Choice Giveback (PPO) are covered with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from no copay up to $575, while observation services cost a $445 copay per stay and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Direct Choice Giveback (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Humana Direct Choice Giveback (PPO) covers ground and air ambulance services with a $315 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
Humana Direct Choice Giveback (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 covered with a $50 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are all covered with a $130 copay per service and no coinsurance.
Primary Care See details
Humana Direct Choice Giveback (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits and physical, occupational, and speech therapies require a $40 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services are covered with a $35 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Direct Choice Giveback (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. However, additional preventive services—including fitness benefits, health education, in-home safety assessments, and caregiver support—are not covered.
Hearing Services See details
Hearing services are covered by Humana Direct Choice Giveback (PPO) with no coinsurance, offering Medicare-covered exams for a $40 copay, routine exams and fittings for no copay, and up to two prescription hearing aids per year for a $699 to $999 copay each. This benefit is partially covered, as over-the-counter (OTC) hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Humana Direct Choice Giveback (PPO) with no deductibles, no coinsurance, and copays ranging from $0 to $40. Covered benefits include one routine eye exam and eyeglasses or contact lenses per year with no copay, while other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Humana Direct Choice Giveback (PPO) up to a $4,000 annual maximum, requiring a $40 copay and no coinsurance for Medicare-covered dental. Other covered services feature no copay and range from no coinsurance to a 30% to 40% coinsurance, though fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Direct Choice Giveback (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance of 0% to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Direct Choice Giveback (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Humana Direct Choice Giveback (PPO), featuring durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Humana Direct Choice Giveback (PPO) with prior authorization required. Diagnostic procedures feature no coinsurance and copays ranging from $0 to $100, while lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Direct Choice Giveback (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Direct Choice Giveback (PPO) with no copay and no coinsurance, but only some services are covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Humana Direct Choice Giveback (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered benefit are not covered.
Other Services See details
Humana Direct Choice Giveback (PPO) partially covers other services, offering acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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