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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 2026 to people living in New York City. This plan received an overall rating of 3 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 $38.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $525.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $475.00 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) plan features an annual drug deductible of $475. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and preferred mail-order services. Tier 2 generic drugs are also highly affordable, costing as little as a $1 copay for a 1-month supply, or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs carry a $30 copay for a 1-month supply at standard pharmacies and preferred mail-order services. For higher-tier medications, Tier 4 non-preferred drugs require a 35% coinsurance, while Tier 5 specialty drugs incur a 27% coinsurance across standard pharmacies and mail-order options. Choosing preferred mail-order and standard pharmacies helps minimize your out-of-pocket prescription costs under this plan.
Additional Benefits
The Humana Direct Choice Giveback (PPO) plan offers comprehensive medical coverage with predictable cost-sharing, including no copay for primary care physician visits and a forty dollar copay for specialists. For hospital care, inpatient stays feature no coinsurance and a four hundred dollar daily copay for the first five days, while outpatient services range from no copay up to an eight hundred and fifty dollar copay. Emergency care is accessible with a one hundred and fifteen dollar copay, which is waived if you are admitted to the hospital within twenty-four hours. This plan also includes key dental, vision, and hearing benefits to minimize your out-of-pocket expenses. Routine vision exams, routine hearing tests, and preventive dental care are covered with no copay and no coinsurance, with dental benefits extending up to a two thousand dollar annual limit. Additionally, diagnostic lab tests and home health services are fully covered with no copay, ensuring affordable access to essential daily care.
Inpatient Hospital See details
Humana Direct Choice Giveback (PPO) covers inpatient hospital services with no coinsurance, requiring a $400 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. Unlimited additional acute care days are covered with no copay, though psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Direct Choice Giveback (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which also feature no copay. Other outpatient services require prior authorization and vary in cost, with outpatient hospital copays ranging from $0 to $850, observation services costing a $400 copay per stay, and outpatient substance abuse sessions requiring a $35 copay.
Partial Hospitalization See details
Humana Direct Choice Giveback (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
Humana Direct Choice Giveback (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Humana Direct Choice Giveback (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 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance. These cost-sharing amounts do not count toward the plan-level deductible.
Primary Care See details
Humana Direct Choice Giveback (PPO) features primary care physician visits with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, mental health, and psychiatric services are covered with a $35 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Humana Direct Choice Giveback (PPO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and chemotherapy wigs. Excluded services include fitness benefits, health education, weight management, nutritional/dietary benefits, and in-home safety assessments.
Hearing Services See details
Hearing services covered by the Humana Direct Choice Giveback (PPO) feature no deductible, with Medicare-covered exams requiring a $40 copay and no coinsurance, and routine exams and fitting evaluations requiring no copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Direct Choice Giveback (PPO) provides partially covered vision services with no deductible, no coinsurance, and no copay for routine eye exams (up to $75 annually) and eyewear like contact lenses and eyeglasses (up to $200 annually). Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
Humana Direct Choice Giveback (PPO) partially covers dental services up to a $2,000 annual combined limit, offering preventive care and most comprehensive services with no copay and no coinsurance, and Medicare-covered dental with a $40 copay and no coinsurance. Restorative and fixed prosthodontics are covered with no copay and 30% to 40% coinsurance, but fluoride, implants, orthodontics, maxillofacial prosthetics, and removable prosthodontics are not covered.
Home Infusion bundled Services See details
Humana Direct Choice Giveback (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, covered Medicare Part B drugs like chemotherapy and others require no copay and 0% to 20% coinsurance, while covered insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Direct Choice Giveback (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Direct Choice Giveback (PPO) covers medical equipment, including durable medical equipment (DME) with an 11% coinsurance and no copay, and prosthetics 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 and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Direct Choice Giveback (PPO), requiring prior authorization with no coinsurance for diagnostic services, no copay for lab tests, and a $0 to $100 copay for diagnostic procedures. Radiological services feature no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Humana Direct Choice Giveback (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Direct Choice Giveback (PPO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, though some services are covered while others are not. Specifically, cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($20 copay) are not covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Direct Choice Giveback (PPO) covers skilled nursing facility (SNF) services 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, no prior three-day hospital stay is needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Direct Choice Giveback (PPO) partially covers other services, providing 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. Over-the-counter (OTC) items are not covered under this plan, and prior authorization is required for the covered benefits.
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