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HumanaChoice Giveback H5216-429 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-429 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-429 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-429 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in ID. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-429 (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 H5216-429 (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 H5216-429 (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 $74.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $350.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $350.00 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 $11350.00 (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 $11350.00 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 H5216-429 (PPO) plan has a $350 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For example, you will pay a $20 copay for preferred generic drugs at standard and mail order pharmacies. For non-preferred drugs, you will pay 28% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice Giveback H5216-429 (PPO) plan offers a range of benefits with varying cost structures. Inpatient hospital stays have copays, with the amount depending on the type of service and length of stay. Outpatient services, including primary care, have copays, and some services like preventive care and home health services have no copay. Other covered services include ambulance, emergency services, and skilled nursing facilities, each with its own cost-sharing arrangement. The plan also offers coverage for hearing, vision, and dental services, some of which have copays. Diagnostic and radiological services have a mix of copays and coinsurance, while medical equipment, dialysis, and home infusion services have coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $430 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you'll pay a $407 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute have no copay. 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 copays ranging from $0 to $430, observation services with a $430 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with copays between $50 and $55 for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice Giveback H5216-429 (PPO) plan. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice Giveback H5216-429 (PPO). Ground ambulance services have a $315 copay, and air ambulance services have a $1250 copay, but there is no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by HumanaChoice Giveback H5216-429 (PPO). Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $110 copay, while Urgently Needed Services has a $45 copay.
Primary Care See details
The HumanaChoice Giveback H5216-429 (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and specialist services with a $55 copay. Mental health and psychiatric individual and group sessions have no copay. Physical therapy and speech-language pathology services have a $35 copay. The plan also covers additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a copay between $50 and $55. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice Giveback H5216-429 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additionally, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with no copay. Some services such as health education, in-home safety assessment, and others are not covered.
Hearing Services See details
Hearing Services are partially covered by the HumanaChoice Giveback H5216-429 (PPO) plan. Hearing exams have a $55 copay, but routine hearing exams and fitting/evaluation for hearing aids are not covered, and prescription and OTC hearing aids are also not covered.
Vision Services See details
Vision Services include eye exams, with a copay between $0 and $55, and eyewear, with no copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5216-429 (PPO) plan covers Medicare Dental Services with a $55 copay, and also covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, and adjunctive general services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-429 (PPO) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment, prosthetics/medical supplies, and diabetic equipment. Durable Medical Equipment has a 5% coinsurance, while medical supplies have a 5% coinsurance, and diabetic supplies have a coinsurance between 10% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $55, and lab services with no copay. Radiological services are also covered, with a maximum copay of $430 for diagnostic services, 20% coinsurance for therapeutic services, and a $10 copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-429 (PPO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice Giveback H5216-429 (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice Giveback H5216-429 (PPO) plan, but require prior authorization. There is no copay for days 1-20, a $214 copay for days 21-75, and no copay for days 76-100.
Other Services See details
The HumanaChoice Giveback H5216-429 (PPO) plan covers acupuncture with a $55 copay per visit, up to 20 treatments per year, and a meal benefit with no copay. Over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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