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HumanaChoice Giveback H7617-003 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H7617-003 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H7617-003 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H7617-003 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Indiana, Ohio, & N KY. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H7617-003 (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 H7617-003 (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 H7617-003 (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 $123.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $425.00 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 $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 H7617-003 (PPO) plan features a $0 drug deductible, allowing your prescription coverage to begin immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay for a 1-month or 3-month supply when using a standard pharmacy or preferred mail order. If you utilize standard mail order for these generic tiers, 1-month copays range from $10 to $20. Tier 3 preferred brand drugs require a $30 copay for a 1-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. For higher-tier medications, you will pay a 35% coinsurance for Tier 4 non-preferred drugs and a 33% coinsurance for Tier 5 specialty drugs. These coinsurance percentages remain consistent across standard pharmacies, preferred mail order, and standard mail order channels.
Additional Benefits
The HumanaChoice Giveback H7617-003 (PPO) plan offers robust coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. For specialist visits, emergency care, and urgent care, members pay predictable copays of $40, $115, and $40 respectively, with no coinsurance required. Inpatient hospital stays require a $400 daily copay for the first few days, after which there is no copay and no coinsurance. For routine wellness, the plan provides essential dental, vision, and hearing benefits, featuring no copay or coinsurance for routine eye exams, select eyewear, and preventive dental care. Prescription hearing aids are covered with copays ranging from $699 to $999, while durable medical equipment and dialysis services require coinsurance instead of copays. Overall, this PPO plan minimizes out-of-pocket coinsurance for most services, relying instead on fixed copays for specialized treatments and hospital care.
Inpatient Hospital See details
Inpatient hospital care is covered by HumanaChoice Giveback H7617-003 (PPO) with no coinsurance, requiring a $400 daily copay for days 1 to 5 of acute stays (no copay for days 6 and beyond) and a $400 daily copay for days 1 to 4 of psychiatric stays (no copay for days 5 to 90). Prior authorization is required, and certain options such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H7617-003 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services carry a copay of $0 to $400, observation services require a $400 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice Giveback H7617-003 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice Giveback H7617-003 (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
HumanaChoice Giveback H7617-003 (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 are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services require a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H7617-003 (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Additional benefits like physical therapy, occupational therapy, and mental health services require copays ranging from $20 to $35 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Giveback H7617-003 (PPO) offers partially covered preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs, memory fitness, and chemotherapy-related wigs. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling services.
Hearing Services See details
HumanaChoice Giveback H7617-003 (PPO) hearing services are partially covered, featuring Medicare-covered exams for a $40 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Up to two prescription hearing aids are covered per year with copays ranging from $699 to $999 and no coinsurance, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services under the HumanaChoice Giveback H7617-003 (PPO) are partially covered, offering routine eye exams and select eyewear with no copay, no coinsurance, and no deductible. While one routine exam and one pair of eyeglasses or contact lenses are covered annually, other eye exams, individual lenses or frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H7617-003 (PPO) provides partially covered dental services with an annual combined maximum benefit of $500, though fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered. Medicare-covered dental services require a $40 copay and no coinsurance, restorative services require a $25 copay and no coinsurance, and preventive care features no copay and no coinsurance.
Home Infusion bundled Services See details
HumanaChoice Giveback H7617-003 (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization. Associated Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice Giveback H7617-003 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
HumanaChoice Giveback H7617-003 (PPO) covers durable medical equipment (DME) with a 13% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H7617-003 (PPO) covers diagnostic and radiological services, featuring no copay and no coinsurance for lab services and diagnostic radiological services. Diagnostic procedures and tests have a copay ranging from $0 to $105 with no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance and no minimum copay.
Home Health Services See details
Home health services are covered under the HumanaChoice Giveback H7617-003 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered by HumanaChoice Giveback H7617-003 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H7617-003 (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and less than a three-day hospital stay is allowed before admission, but additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
HumanaChoice Giveback H7617-003 (PPO) partially covers other services, offering acupuncture for a $40 copay and no coinsurance, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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