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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Humana Direct Choice Giveback (PPO) is a PPO plan offered by Emphesys Insurance Company available for the 2026 plan year to people living in Central Florida. This plan received an overall rating of 4.5 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 $130.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $290.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $130.00 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 $6750.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6750.00 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 $6750.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6750.00 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 Humana Direct Choice Giveback (PPO) plan features an annual drug deductible of $130. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with a $1 copay for a 1-month supply at standard pharmacies, and no copay for a 3-month supply when using preferred mail order. 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 copays are higher. For advanced medications, Tier 4 non-preferred drugs carry a 42% coinsurance, and Tier 5 specialty drugs require a 31% coinsurance across standard pharmacies and mail order options.
Additional Benefits
The Humana Direct Choice Giveback (PPO) plan offers affordable access to everyday medical care, featuring no copays and no coinsurance for primary care doctor visits, annual physicals, and preventive screenings. Specialist visits require a $50 copay, while emergency room care has a $130 copay and urgent care visits carry a $40 copay. Routine dental, vision, and hearing exams are also highly accessible with no copays or coinsurance. For advanced medical needs, inpatient hospital stays require a $400 daily copay for the first seven days with no copay for subsequent days, and skilled nursing care is covered with no copay for the first 20 days. Diagnostic lab work and home health services require no copay, while durable medical equipment and dialysis services feature no copay but require a 15% to 20% coinsurance. Comprehensive dental services are covered up to a $2,000 annual limit, and prescription hearing aids are partially covered up to $500 per ear.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Humana Direct Choice Giveback (PPO) with no coinsurance, featuring a $400 daily copay for days 1 to 7 of acute stays (no copay for days 8 and beyond) and a $400 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Room upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Direct Choice Giveback (PPO) with no coinsurance, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay of $0 to $295, while observation services require a $400 copay per stay and outpatient substance abuse sessions carry a $30 to $35 copay.
Partial Hospitalization See details
Humana Direct Choice Giveback (PPO) covers partial hospitalization with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Direct Choice Giveback (PPO) covers emergency ambulance services with prior authorization, requiring a copay of $190.00 to $240.00 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Direct Choice Giveback (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 are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
Humana Direct Choice Giveback (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $50 copay and no coinsurance. Additional benefits like mental health, psychiatric, physical, and occupational therapies are covered with copays ranging from $30 to $40 and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by the Humana Direct Choice Giveback (PPO), featuring annual physical exams, kidney disease education, memory fitness, and select screenings with no copays and no coinsurance. However, several supplemental benefits are not covered under this plan, including health education, weight management, nutritional therapy, and in-home safety assessments.
Hearing Services See details
Humana Direct Choice Giveback (PPO) covers hearing services, featuring Medicare-covered exams for a $50 copay and no coinsurance, plus routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $500 annual limit per ear, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Direct Choice Giveback (PPO) offers partially covered vision services with no coinsurance and no deductible, including no copay for one routine eye exam and one pair of eyeglasses or contact lenses per year. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Direct Choice Giveback (PPO) up to a $2,000 annual limit, offering no copay and no coinsurance for preventive care, while Medicare-covered dental requires a $50 copay and no coinsurance. Comprehensive services feature no copay with coinsurance ranging from 0% to 40%, but fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Direct Choice Giveback (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Humana Direct Choice Giveback (PPO) plan 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 durable medical equipment and medical supplies with a 15% coinsurance and no copay. Prosthetic devices and diabetic supplies require a 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts are covered with a $5 copay and no coinsurance.
Diagnostic and Radiological Services See details
Humana Direct Choice Giveback (PPO) covers diagnostic and radiological services, with prior authorization required. Lab, outpatient X-ray, and diagnostic radiological services feature no copay, while diagnostic procedures range from no copay to a $150 copay and therapeutic services require a minimum $45 copay. A 20% coinsurance applies to diagnostic procedures and therapeutic services, with no coinsurance for diagnostic radiological services, and applicable coinsurance for lab and X-ray services.
Home Health Services See details
Home Health Services are covered under the Humana Direct Choice Giveback (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Direct Choice Giveback (PPO) provides cardiac rehabilitation services with no coinsurance and required prior authorization, meaning some services are covered. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require copays of $15 to $30.
Skilled Nursing Facility (SNF) See details
Humana Direct Choice Giveback (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $160 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Direct Choice Giveback (PPO) partially covers other services, offering acupuncture with no copay and no coinsurance for up to 25 treatments per year with prior authorization. Supplemental benefits like over-the-counter items and meal benefits 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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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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