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HumanaChoice Giveback H5216-438 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5216-438 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5216-438 (PPO) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
HumanaChoice Giveback H5216-438 (PPO) is a PPO plan offered by Humana Inc. available for the 2025 plan year to people living in Denver. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5216-438 (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 H5216-438 (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 H5216-438 (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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $220.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7850.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7850.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $14000.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 H5216-438 (PPO) plan has a $220 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for a standard pharmacy, you will pay a $5 copay for preferred generic drugs, a $45 copay for standard generic drugs, and 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice Giveback H5216-438 (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with varying copays and coinsurance, as well as emergency and ambulance services. Additional benefits include coverage for primary care, hearing, vision, and dental services, with specific copays and annual maximums. The plan also covers home health, medical equipment, and diagnostic services, and offers a number of other services, such as acupuncture and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you pay a $370 copay for days 1-5, and no copay for days 6-90; additional days for acute care have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance and a copay between $0 and $50, and observation services with a $370 copay. Ambulatory Surgical Center (ASC) Services are covered with a coinsurance of 20%, and Outpatient Substance Abuse Services are covered with a $20 copay per individual or group session. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground ambulance services with a $315 copay and air ambulance services with a $1250 copay; however, transportation services to any health-related location are not covered. There is no coinsurance for ambulance services.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $110 copay. Urgently Needed Services have a 20% coinsurance.
Primary Care See details
Primary Care Physician Services have a $20 copay, Chiropractic Services have a $15 copay, and Occupational Therapy Services have 20% coinsurance. Physician Specialist Services have a $55 copay, and Mental Health Specialty Services and Psychiatric Services have a $20 copay for individual and group sessions. Podiatry Services and Other Health Care Professional services have a $55 copay. Physical Therapy and Speech-Language Pathology Services have 20% coinsurance, while Additional Telehealth Benefits have a $0-$55 copay and 20% coinsurance, and Opioid Treatment Program Services have a $20 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include Medicare-covered services, annual physical exams, and additional preventive services. Annual physical exams have no copay, while additional preventive services may have copays. The plan also covers kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $55 copay, routine hearing exams with no copay for 1 visit every year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $699 and $999 for all types of prescription hearing aids, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$55, and eyewear has no copay, with a combined maximum of $150 per year for contact lenses and eyeglasses, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $55 copay, and a $1,000 annual maximum benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5216-438 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 12% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have between 10% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered with a coinsurance of at most 20%, and Diagnostic Procedures/Tests have a copay of at most $55.00, while Lab Services have no copay. Radiological Services are covered with a coinsurance of at most 20%, Diagnostic Radiological Services have no copay, Therapeutic Radiological Services have a copay of at most $50.00, and Outpatient X-Ray Services have a $20.00 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5216-438 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
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 this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice Giveback H5216-438 (PPO) plan, with no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services," HumanaChoice Giveback H5216-438 (PPO) covers acupuncture with a $55 copay and a limit of 20 treatments per year, and meal benefits with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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