A non-government entity
HumanaChoice Giveback H5216-433 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-433 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-433 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5216-433 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in El Paso County. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5216-433 (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 H5216-433 (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 H5216-433 (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 $174.00. 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 $130.00 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:
Sign up for HumanaChoice Giveback H5216-433 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice Giveback H5216-433 (PPO) Medicare plan features an annual drug deductible of $130. 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, starting at a $1 copay for a 1-month supply, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $30 copay for a 1-month supply at standard pharmacies or preferred mail order. For Tier 4 non-preferred drugs, you will pay a 36% coinsurance, while Tier 5 specialty drugs carry a 31% coinsurance for a 1-month supply across standard pharmacies and mail order options.
Additional Benefits
The HumanaChoice Giveback H5216-433 (PPO) plan provides comprehensive healthcare coverage featuring no copay and no coinsurance for primary care visits, routine preventive services, home health, and cardiac rehabilitation. For specialist visits, there is a $35 copay, while inpatient hospital stays require a $295 daily copay for the first six days and no copay thereafter. Outpatient hospital services range from no copay up to a $350 copay with no coinsurance, making essential medical care highly accessible. This plan also includes key supplemental benefits, offering routine dental, vision, and hearing exams with no copay or coinsurance, alongside coverage for eyewear and hearing aids. For specialized medical needs, durable medical equipment is covered with a 9% coinsurance and no copay, while dialysis services require a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
HumanaChoice Giveback H5216-433 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $295 daily copay for days 1 through 6, followed by no copay for days 7 through 90. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H5216-433 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 to $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice Giveback H5216-433 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5216-433 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by HumanaChoice Giveback H5216-433 (PPO) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care services under HumanaChoice Giveback H5216-433 (PPO) feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $35 copay and no coinsurance. Therapy services require a $25 copay, mental health and psychiatric sessions have a $30 copay, and telehealth ranges from a $0 to $40 copay with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice Giveback H5216-433 (PPO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, glaucoma screenings, diabetes training, rectal exams, EKGs, and a fitness benefit. Non-covered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy 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 modifications, and counseling.
Hearing Services See details
HumanaChoice Giveback H5216-433 (PPO) covers hearing services with a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a $699 to $999 copay, excluding inner ear, outer ear, and over the ear models, while OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice Giveback H5216-433 (PPO) with no copay, no coinsurance, and no deductible for routine exams and select eyewear, subject to annual maximum limits of $75 and $150 respectively. While one routine exam and one pair of contact lenses or eyeglasses (lenses and frames) are covered each year, other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5216-433 (PPO) offers partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care like cleanings, exams, and x-rays. While comprehensive services like endodontics and periodontics are covered, fluoride treatments, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5216-433 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, insulin, and other drugs, are covered with a 0% to 20% coinsurance and a copay of up to $35 for insulin.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice Giveback H5216-433 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice Giveback H5216-433 (PPO) covers medical equipment, offering durable medical equipment (DME) with a 9% coinsurance and no copay. Prosthetic devices and medical supplies require a 10% coinsurance and no copay, while diabetic supplies carry a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the HumanaChoice Giveback H5216-433 (PPO) plan, featuring no copay or coinsurance for lab services and outpatient X-rays. Diagnostic procedures and tests require no coinsurance and a copay between $0 and $175, while therapeutic radiological services require a minimum $40 copay and 20% coinsurance.
Home Health Services See details
Home health services are covered by HumanaChoice Giveback H5216-433 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the HumanaChoice Giveback H5216-433 (PPO) plan with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5216-433 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare limit are not covered.
Other Services See details
HumanaChoice Giveback H5216-433 (PPO) partially covers other services, offering acupuncture for a $35 copay and no coinsurance for up to 20 treatments per year, as well as chronic illness meal benefits with no copay or coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved