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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 Collin and Denton counties. 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 $74.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $375.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $115.00 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 $13900.00 (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 $13900.00 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) prescription drug plan features an annual drug deductible of $115. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, requiring only a $1 copay for a one-month supply at standard pharmacies and preferred mail order, or no copay for a three-month preferred mail order supply. Tier 3 preferred brand drugs cost a $30 copay for a one-month supply at standard pharmacies or through preferred mail order. For higher-tier medications, you will pay a 37% coinsurance for Tier 4 non-preferred drugs and a 31% coinsurance for Tier 5 specialty drugs across standard pharmacies and mail order options.
Additional Benefits
The Humana Direct Choice Giveback (PPO) plan offers affordable healthcare coverage with no copay or coinsurance for primary care visits, annual physical exams, and home health services. Specialist visits, urgent care, and emergency services are accessible with predictable flat copayments and no coinsurance. For hospital care, members pay a daily copay for the first few days of inpatient stays with no coinsurance, while outpatient services range from no copay up to a $350 copay. This plan also includes strong supplemental benefits, featuring up to $1,500 in dental coverage and routine hearing and vision exams with no copays or coinsurance. Prescription hearing aids are covered with copays ranging from $699 to $999, while durable medical equipment requires a 10% coinsurance with no copay. Additionally, diagnostic services like lab tests and outpatient X-rays are covered with no copay, making essential care highly accessible.
Inpatient Hospital See details
Humana Direct Choice Giveback (PPO) covers inpatient hospital services with no coinsurance, requiring a $340 daily copay for days 1 to 7 of acute stays and days 1 to 6 of psychiatric stays, with no copay for subsequent days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Direct Choice Giveback (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $350 and observation services with a $340 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a copay of $30 to $35 with no coinsurance.
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 for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Humana Direct Choice Giveback (PPO), with ground ambulance services requiring a $335 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay, both subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Humana Direct Choice Giveback (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both featuring no coinsurance and no deductible. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Direct Choice Giveback (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay with no coinsurance. Other covered benefits, including physical therapy, mental health, and telehealth services, feature copays ranging from $0 to $40 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered under the Humana Direct Choice Giveback (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and other services like glaucoma screenings and diabetes self-management. Additional preventive services are partially covered, offering a memory fitness benefit with no copay and no coinsurance, but excluding 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, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Humana Direct Choice Giveback (PPO) covers routine hearing exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 and no coinsurance for up to two devices per year, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Direct Choice Giveback (PPO) partially covers vision services with no deductible, no coinsurance, and copays ranging from no copay to $40 for eye exams and no copay for eyewear. While routine eye exams, contact lenses, and eyeglasses are covered up to annual limits, other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Direct Choice Giveback (PPO) partially covers dental services up to a $1,500 annual maximum, offering no copay and no coinsurance for covered preventive and comprehensive services, while Medicare-covered dental has a $40 copay and no coinsurance. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Direct Choice Giveback (PPO) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, insulin, and other drugs, have a coinsurance ranging from no coinsurance up to 20%, with insulin 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
Humana Direct Choice Giveback (PPO) covers durable medical equipment (DME) with a 10% coinsurance and no copay, and prosthetics and medical supplies with a 15% 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
Humana Direct Choice Giveback (PPO) covers diagnostic and radiological services with prior authorization, offering lab services, diagnostic radiology, and outpatient X-rays with no copays. Diagnostic procedures and tests carry no coinsurance with a copay ranging from $0 to $175, while therapeutic radiology requires a $40 copay and 20% coinsurance.
Home Health Services See details
Humana Direct Choice Giveback (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Direct Choice Giveback (PPO) with no coinsurance and require prior authorization. However, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice, carrying copayments of $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Direct Choice Giveback (PPO) with no coinsurance, featuring no 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 inpatient hospital stay is not required, additional days beyond the 100-day Medicare limit 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 chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered services, and over-the-counter (OTC) items are not covered.
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