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HumanaChoice Giveback H5970-030 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5970-030 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5970-030 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5970-030 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in New York. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5970-030 (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 H5970-030 (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 H5970-030 (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 $330.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 HumanaChoice Giveback H5970-030 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generics are also highly affordable, with standard pharmacy and preferred mail order options costing just a $1 copay for a 1-month supply, and no copay for a 3-month preferred mail order. Tier 3 preferred brand drugs require a $33 copay for a 1-month supply at standard pharmacies and through preferred mail order. For higher-tier medications, you will pay coinsurance instead of a flat copay, which includes 39% coinsurance for Tier 4 non-preferred drugs and 25% coinsurance for Tier 5 specialty drugs. Utilizing preferred mail order and standard pharmacies helps minimize your out-of-pocket expenses for most tiers.
Additional Benefits
The HumanaChoice Giveback H5970-030 (PPO) plan offers robust coverage for essential medical care, featuring no copays for primary care visits and routine preventive services. For specialized care, members pay a $40 copay for specialists, while inpatient hospital stays require a daily copay of $380 for the first seven days of acute care with no coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted, and ambulance services require a $315 copay. This plan also includes valuable supplemental benefits, including dental coverage with a $1,500 annual limit and no copays for routine dental care. Members benefit from no copays on routine vision and hearing exams, along with a $250 annual vision allowance and affordable copays for hearing aids. Skilled nursing facility stays have no copay for the first 20 days, while durable medical equipment is covered with a 15% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice Giveback H5970-030 (PPO) covers inpatient hospital stays with no coinsurance, requiring a daily copay of $380 for days 1-7 of acute stays (no copay for days 8 and beyond) and $290 for days 1-7 of psychiatric stays (no copay for days 8-90). Prior authorization is required, and certain services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H5970-030 (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $1,025 for outpatient hospital services, $380 per stay for observation services, and $35 for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, although prior authorization is required for most services.
Partial Hospitalization See details
HumanaChoice Giveback H5970-030 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice Giveback H5970-030 (PPO), which features a $315 copay and no coinsurance for both ground and air ambulance services, with prior authorization required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
HumanaChoice Giveback H5970-030 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5970-030 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Most other professional services, including physical therapy, occupational therapy, and mental health sessions, require a $35 copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
HumanaChoice Giveback H5970-030 (PPO) preventive services are partially covered, featuring no copay and no coinsurance for annual physical exams, kidney disease education, and Medicare-covered screenings. While chemotherapy-related wigs are covered up to $500 annually with no copay, other additional services like fitness benefits, health education, nutritional therapy, weight management, and in-home support are not covered.
Hearing Services See details
HumanaChoice Giveback H5970-030 (PPO) covers Medicare-covered hearing exams for a $40 copay and routine exams and fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H5970-030 (PPO) partially covers vision services with no copay and no coinsurance, providing one routine eye exam and a $250 annual allowance for contact lenses or eyeglasses (lenses and frames). Other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
HumanaChoice Giveback H5970-030 (PPO) offers partially covered dental services with a maximum annual benefit of $1,500 for both in-network and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered dental services have no copay and no coinsurance. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5970-030 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
HumanaChoice Giveback H5970-030 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
HumanaChoice Giveback H5970-030 (PPO) covers durable medical equipment (DME) with a 15% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5970-030 (PPO) covers diagnostic and radiological services subject to prior authorization. Diagnostic services require no coinsurance, with no copay for lab tests and a $0 to $100 copay for diagnostic procedures, while radiological services feature no copay for outpatient X-rays, a minimum $0 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiation.
Home Health Services See details
Home Health Services are covered under the HumanaChoice Giveback H5970-030 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the HumanaChoice Giveback H5970-030 (PPO) plan with no coinsurance and prior authorization, though only some services are covered. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for PAD ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5970-030 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no 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 additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Giveback H5970-030 (PPO) partially covers other services, offering acupuncture for a $40 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
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