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HumanaChoice Giveback H7617-011 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H7617-011 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H7617-011 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H7617-011 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Eastern Wisconsin. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H7617-011 (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 H7617-011 (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 H7617-011 (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 $51.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 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 $10100.00 (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 $10100.00 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 H7617-011 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications cost a $10 copay for a 1-month supply at standard pharmacies and preferred mail order, though you can get a 3-month supply with no copay through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply at standard pharmacies and through mail order. Tier 4 non-preferred drugs require a 47% coinsurance, while Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply. Understanding these copays, coinsurance rates, and the deductible helps you accurately project your annual out-of-pocket drug costs with this PPO plan.
Additional Benefits
The HumanaChoice Giveback H7617-011 (PPO) plan offers affordable medical coverage with no copay for primary care physician visits, preventive care services, and routine dental, vision, and hearing exams. For specialized medical care, members pay a $45 copay for specialist visits and a $130 copay for emergency room services, which is waived if admitted to the hospital. Inpatient hospital stays require a daily copay of $425 for the first five days, followed by no copay for days six through ninety. This plan also features a $2,000 annual limit for covered dental services and provides routine eyewear and over-the-counter hearing aids with no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay. Skilled nursing facility care is covered with a $10 daily copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice Giveback H7617-011 (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $425 for days 1 through 5 and no copay for days 6 through 90. Acute stays include unlimited additional days with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H7617-011 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $425 copay per stay for observation services. Outpatient substance abuse sessions have a $30 to $35 copay and no coinsurance, while ambulatory surgical center and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
HumanaChoice Giveback H7617-011 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HumanaChoice Giveback H7617-011 (PPO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice Giveback H7617-011 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits under the HumanaChoice Giveback H7617-011 (PPO) feature primary care physician visits with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Physical, occupational, and speech therapies require a $40 copay and no coinsurance, mental health services have a $30 copay and no coinsurance, and podiatry is not covered, while some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
HumanaChoice Giveback H7617-011 (PPO) partially covers preventive services with no copay and no coinsurance for covered care, such as annual exams, kidney education, and fitness benefits. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice Giveback H7617-011 (PPO) offers hearing services with no coinsurance, featuring a $45 copay for Medicare-covered exams, and no copay for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with a copay of $199 to $799 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H7617-011 (PPO) offers partially covered vision services with no deductible, no copay, and no coinsurance for routine eye exams and eyewear, though prior authorization is required. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
HumanaChoice Giveback H7617-011 (PPO) provides partially covered dental services with an annual maximum benefit of $2,000, featuring no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $45 copay and no coinsurance, prosthodontics require a 30% coinsurance with no copay, and fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H7617-011 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, insulin, and other drugs require coinsurance ranging from no coinsurance to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice Giveback H7617-011 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice Giveback H7617-011 (PPO), with prior authorization required for most items. Durable medical equipment, prosthetics, and medical supplies carry a 20% coinsurance and no copay, while diabetic supplies have a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the HumanaChoice Giveback H7617-011 (PPO) plan, with prior authorization required for most services. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $95, while lab services and outpatient X-rays are available with no copay. Diagnostic radiological services feature copays starting at $0, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HumanaChoice Giveback H7617-011 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HumanaChoice Giveback H7617-011 (PPO) with no copay and no coinsurance; however, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H7617-011 (PPO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the standard 100-day Medicare limit are not covered. Covered days require no coinsurance, with a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100 under prior authorization.
Other Services See details
Other services are partially covered by HumanaChoice Giveback H7617-011 (PPO), which includes acupuncture for a $45 copay and no coinsurance, and both over-the-counter items and chronic illness meals with no copay and no coinsurance. Sub-services listed as Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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