Prior Authorization Required [snf] =>
Prior Authorization Required [pcp] => Not Covered [specialist] => $15 Copay
Prior Authorization Required [urgent_care] => $35 Copay
Prior Authorization Required [er] => $0 - $470 Copay
Prior Authorization Required [ambulance_ground] => $315 Copay
Prior Authorization Required [ambulance_air] => $315 Copay
Prior Authorization Required [dental] =>
$1500 max [vision] =>
Prior Authorization Required [hearing] => Not Covered [rx] => Array ( [deductible] => $200 [tiers] => Array ( [0] => Array ( [order] => 1 [name] => Tier 1 [deductible] => Excluded [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) [1] => Array ( [order] => 2 [name] => Tier 2 [deductible] => Excluded [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) [2] => Array ( [order] => 3 [name] => Tier 3 [deductible] => Applies [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) [3] => Array ( [order] => 4 [name] => Tier 4 [deductible] => Applies [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) [4] => Array ( [order] => 5 [name] => Tier 5 [deductible] => Applies [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) ) ) )
HumanaChoice Giveback H5216-226 (PPO) (PPO) 2025 Plan Details for Clark County, Indiana Residents
HumanaChoice Giveback H5216-226 (PPO) (PPO) 2025 Plan Details for Clark County, Indiana Residents
HumanaChoice Giveback H5216-226 (PPO) is a PPO Medicare Advantage plan, from Humana, {with_without_pdp} a prescription drug plan. It's CMS Plan ID is: H5216-226-0. It is not available in all areas. The list of locations where this plan is available can be found below.
According to CMS enrollment data (July, 2025), there are approximately 2,436 members enrolled in this plan.
HumanaChoice Giveback H5216-226 (PPO) (PPO) Overview
| CMS Fact | Landscape Value |
|---|---|
| Health Plan ID: | H5216-226-0 |
| CMS Overall Rating: | 0.0 out of 5 stars* |
| Medicare Advantage Plan Type: | PPO |
| Coverage Year: | CY2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $6600.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Hearing |
| Availability: | Clark County, IN |
| Insured By: | Humana |
| Last Plan Content Update: |
Plan Availability by Location
Health Plan Out-of-Pocket Costs
Doctor's Office Visits
Check your costs for primary care and specialist visits, plus what’s included for preventive care.
- Primary:
$0 Copay - Specialist:
$50 Copay - Back to Top
Emergency, Urgent, and Inpatient Hospital Coverage
See your costs for ER visits, urgent care, ambulance rides, hospital stays, and skilled nursing care.
- Emergency room care:
$110 Copay - Urgent care:
$45 Copay - Ground ambulance:
$315 Copay - Inpatient hospital care:
$470.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond - Skilled Nursing Facility:
$0.00 per day for days 1 through 20
$214.00 per day for days 21 and beyond - Back to Top
Foot Care
Learn what’s covered for Medicare-approved foot exams and routine podiatry services.
- Foot Exams and Treatments (Medicare-covered):
$50 Copay
Prior Authorization Required - Routine Foot Care:
Not Covered - Back to Top
Chiropractic Care
Understand your costs for Medicare-approved chiropractic services and routine adjustments.
- Medicare-covered chiropractic:
$15 Copay
Prior Authorization Required - Routine chiropractic:
Not Covered - Back to Top
Mental Health Services
Find out the costs for outpatient therapy sessions and inpatient psychiatric care.
- Outpatient individual therapy:
$45 Copay - Outpatient group therapy:
$45 Copay - Inpatient psychiatric hospital care:
$470.00 per day for days 1 through 4
$0.00 per day for days 5 and beyond - Back to Top
Rehabilitation Services
See coverage details for physical, speech, and occupational therapy.
- Physical therapy and speech and language therapy:
$35 Copay
Prior Authorization Required - Occupational therapy:
$35 Copay
Prior Authorization Required - Back to Top
Medical Equipment and Supplies
Check your share of costs for diabetes supplies, durable equipment, and prosthetics.
- Diabetes supplies:
20% Coinsurance
Prior Authorization Required - Durable medical equipment:
19% Coinsurance
Prior Authorization Required - Prosthetics:
20% Coinsurance - Back to Top
Diagnostics, Lab Services, and Imaging
Review your costs for lab work, imaging, x-rays, and diagnostic testing.
- Diagnostic radiology services:
$720 Copay
Prior Authorization Required - Lab services:
$45 Copay
Prior Authorization Required - Outpatient x-rays:
$130 Copay
Prior Authorization Required - Diagnostic tests and procedures:
$105 Copay
Prior Authorization Required - Back to Top
Medicare Part B Drugs
See what you’ll pay for chemotherapy and other Medicare-covered Part B drugs.
- Chemotherapy:
20% Coinsurance - Other Part B drugs (Medicare-covered):
20% Coinsurance - Back to Top
Dental Services
Learn about preventive, diagnostic, and comprehensive dental benefits.
- Medicare Covered Preventive Dental:
Prescription Drug Costs & Benefits
HumanaChoice Giveback H5216-226 (PPO) includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
HumanaChoice Giveback H5216-226 (PPO) Prescription Drug Plan Premium Details Basic Part D Premium: $$0.00 Supplemental Part D Premium: $$0.00 Total Part D Premium: $$0.00 Low-Income Premium Subsidy: ${part_d_lips_amount} Low-Income Premium Subsidy Paid by CMS: $$0.00 Low-Income Subsidy Premium: $$0.00 For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $615.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Humana starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, HumanaChoice Giveback H5216-226 (PPO) may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
HumanaChoice Giveback H5216-226 (PPO) Pharmacy Out-of-Pocket Costs by Drug Tier Drug Tier Retail Mail Order Preferred Generic* $0.00 $10.00 Generic* $10.00 $20.00 Preferred Brand $47.00 $47.00 Non-Preferred Drug 50.00% 50.00% Specialty Tier 30.00% 30.00% *Deductible does not apply. CMS 5-Star Rating Marks
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
2026 Medicare Star Ratings for HumanaChoice Giveback H5216-226 (PPO) CMS Measure Star Rating 2026 Overall Rating Staying Healthy: Screenings, Tests, Vaccines Managing Chronic (Long Term) Conditions Member Experience with Health Plan Complaints and Changes in Plans Performance Health Plan Customer Service Drug Plan Customer Service Complaints and Changes in the Drug Plan Member Experience with the Drug Plan Drug Safety and Accuracy of Drug Pricing Need Help Enrolling?
Contact and Resource Information for Humana Website: Humana Plan Page Providers: Humana Providers Page Formulary: Humana Formulary Page Pharmacy: Humana Pharmacy Page New Member Health Plan Help: (800)833-2364 New Member Health Plan TTY: 711 New Member Part D Help: (800)833-2364 New Member Part D TTY Users: 711 Frequently Asked Questions
📘 What does Medicare plan code H5216 226 mean?
HumanaChoice Giveback H5216-226 (PPO) is a Medicare Advantage plan by Humana. The code H5216 is the CMS contract ID, whereas 226 is its plan ID.
- Plan Name: HumanaChoice Giveback H5216-226 (PPO)
- Plan Type: PPO
- Premium: $0.00/mo + your monthly Part B premium
- Out-of-Pocket Max: $6600.00 (in-network)
- Drug Coverage: {pdp_faq_summary}
- CMS Star Rating: 0.0 out of 5
- Contract Year: 2026
This information is based on official CMS data and is provided for educational purposes. Always review your plan’s official documents or contact the provider directly before making enrollment decisions.
📋 What type of plan is H5216 226?
This plan is a PPO — specifically, it's an PPO plan with a Medicare Advantage contract that's offered by Humana. It comes with defined provider network rules you should be aware of.
- Plan Marketing Name: HumanaChoice Giveback H5216-226 (PPO)
- Network Type: {plan_type_expanded}
- Referral Requirement: {referral_required_expanded}
- Prescription Coverage: {pdp_faq_summary}
Plan types like HMOs and PPOs determine whether you can go out-of-network or need referrals to see specialists.
📦 What benefits are included in H5216 226?
This plan covers all Medicare Part A and Part B services. Depending on the plan, it may also include valuable extras like dental, vision, and hearing benefits.
- Medical Services: Hospital, doctor visits, preventive care
- Prescription Drugs: Enhanced, $615.00 deductible
- Dental: {dental_benefit}
- Vision: {vision_benefit}
- Hearing: {hearing_benefit}
Benefit availability may vary by location and plan version. Confirm specific details in your plan's Evidence of Coverage (EOC).