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HumanaChoice Giveback H5216-435 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-435 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-435 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5216-435 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in AZ, CO, NM. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-435 (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 H5216-435 (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 H5216-435 (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 $55.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $14000.00 (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 $14000.00 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 H5216-435 (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay no copay for preferred generic drugs at a standard pharmacy, and a $20 copay for standard mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice Giveback H5216-435 (PPO) plan offers a range of benefits including inpatient and outpatient hospital services with varying copays and coinsurance, as well as coverage for ambulance, emergency, and primary care services. It also includes preventive services, hearing, vision, and dental coverage, along with home health, skilled nursing, and other services like acupuncture and over-the-counter items. Many services require prior authorization, and costs vary depending on the specific service, with some services having a copay, coinsurance, or both.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $400 copay for days 1-5, and no copay for days 6-90, with additional days 91-999 having no copay; Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a $400 copay for days 1-5, and no copay for days 6-90; Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $0-$50 copay and 20% coinsurance, observation services with a $400 copay, ambulatory surgical center services with no copay and 20% coinsurance, outpatient substance abuse services with a $20 copay, and outpatient blood services with no copay. Prior authorization is required for all of these services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $20 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice Giveback H5216-435 (PPO) plan. Ground ambulance services have a $315 copay, while air ambulance services have a $1250 copay; both have no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the HumanaChoice Giveback H5216-435 (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice Giveback H5216-435 (PPO) plan covers primary care physician services with a $20 copay, chiropractic services with a $15 copay, and occupational therapy services with a 20% coinsurance. Physician specialist services have a $50 copay, while mental health and psychiatric services have a $20 copay for individual and group sessions. Podiatry services and other health care professionals have a $50 copay. Physical therapy and speech-language pathology services have a 20% coinsurance, and additional telehealth benefits have a copay between $0 and $50. Opioid treatment program services have a $20 copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, as well as additional preventive services, kidney disease education services, and other preventive services. Additional preventive services, kidney disease education services, and other preventive services have a copay, and services like health education, in-home safety assessment, and others are not covered.
Hearing Services See details
The HumanaChoice Giveback H5216-435 (PPO) plan covers hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) having a copay between $699 and $999, while other types of Prescription Hearing Aids are not covered. The plan also covers OTC hearing aids.
Vision Services See details
Vision services include coverage for eye exams, with a copay between $0 and $50, and eyewear, including contact lenses and eyeglasses, with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5216-435 (PPO) plan covers Medicare Dental Services with a $50 copay, as well as Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services with no copay. This plan does not cover Fluoride Treatment, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-435 (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered under the HumanaChoice Giveback H5216-435 (PPO) plan, including Durable Medical Equipment (DME) with 12% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests have a copay of up to $50 and a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have no copay and a coinsurance of at most 20%, Therapeutic Radiological Services have a copay of up to $50 and a coinsurance of at most 20%, and Outpatient X-Ray Services have a $20 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-435 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; there is no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $50 copay, over-the-counter items with a maximum benefit coverage amount of $50 every three months, and a meal benefit with no copay. Several other services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services.
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