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Humana Full Access Giveback H5216-393 (PPO) - H5216-393-000

na* for plan year 2025

$0.00

Monthly Premium

Humana Full Access Giveback H5216-393 (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.

Plan ID: H5216-393-000

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$0.00

Monthly Premium

Florida Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Florida Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

CoverageDetails
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$6,700.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$2,000.00
Primary care doctor visit
Out-of-Network:

Doctor Office Visit Services:
Copayment for Medicare Covered Primary Care Office Visit $0
Specialty doctor visit
Out-of-Network:

Doctor Specialty Visit Services:
Copayment for Medicare Covered Physician Specialist Office Visit $45
Inpatient hospital care
Out-of-Network:

Acute Hospital Services:
$350 per day for days 1 to 7
$0 per day for days 8 to 90
Urgent care
Urgent Care:
Copayment for Urgent Care $15

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $125
Emergency room visit
Emergency Care:
Copayment for Emergency Care $125
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $125
Copayment for Worldwide Emergency Transportation $125
Ambulance transportation
Out-of-Network:

Ambulance Services:
Copayment for Medicare Covered Ambulance Services - Ground $190 to $240
Coinsurance for Medicare Covered Ambulance Services - Air 20%
$240 Ambulance Emergency - Ground Ambulance$190 Ambulance Non-Emergency - Ground Ambulance_

Health Care Services and Medical Supplies

Humana Full Access Giveback H5216-393 (PPO) covers a range of additional benefits. Learn more about Humana Full Access Giveback H5216-393 (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

CoverageDetails
Chiropractic servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $15
Prior Authorization Required for Chiropractic Services
Diabetes supplies, training, nutrition therapy and monitoring
Out-of-Network:

Medicare Covered Diabetic Supplies and Services:
Copayment for Medicare Covered Diabetic Supplies $0
Coinsurance for Medicare Covered Diabetic Supplies 20%
Copayment for Medicare Covered Diabetic Therapeutic Shoes or Inserts $10
Durable medical equipment (DME)In-Network:

Durable Medical Equipment:
Copayment for Medicare-covered Durable Medical Equipment $0
Coinsurance for Medicare-covered Durable Medical Equipment 3%
Prior Authorization Required for Durable Medical Equipment
$0 Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy3% DME - DME Prov3% DME - Pharmacy$0 DME-Oxygen System - DME Prov_
Diagnostic tests, lab and radiology services, and X-raysIn-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $150
Coinsurance for Medicare-covered Diagnostic Procedures/Tests 20%
Copayment for Medicare-covered Lab Services $0 to $50
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
20% OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$45 OP Diag Proc & Tests - SPC$15 OP Diag Proc & Tests - UCC$150 Sleep Study (Fac Based) - OPH$150 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home_

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0 to $295
Copayment for Medicare-covered Therapeutic Radiological Services $45
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Copayment for Medicare-covered X-Ray Services $0 to $110
Home health careIn-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Mental health inpatient care
Out-of-Network:

Psychiatric Hospital Services:
$350 per day for days 1 to 5
$0 per day for days 6 to 90
Mental health outpatient care
Out-of-Network:

Medicare Covered Mental Health Services:
Copayment for Medicare Covered Individual Sessions $30
Copayment for Medicare Covered Group Sessions $30
Outpatient services/surgery
Out-of-Network:

Medicare Covered Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0 to $295
Copayment for Medicare Covered Ambulatory Surgical Center Services $0 to $175
$0 Diag Colonoscopy - OPH$60 Mental Health - OPH$295 Surgery Svcs - OPH$45 Wound Care - OPH_
Outpatient substance abuse care
Out-of-Network:

Medicare Covered Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual Sessions $30 to $100
Copayment for Medicare Covered Group Sessions $30 to $100
$100 OP Substance Abuse Care - OPH$30 OP Substance Abuse Care - SPC_
Podiatry services
Out-of-Network:

Medicare Covered Podiatry Services:
Copayment for Medicare Covered Podiatry Services $45
Skilled Nursing Facility (SNF) careIn-Network:

Skilled Nursing Facility Services:
$0 per day for days 1 to 20
$160 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Dental care0% coinsurance for comprehensive oral evaluation or periodontal exam up to 1 every 3 years.
0% coinsurance for panoramic film or diagnostic x-rays up to 1 every 5 years.
0% coinsurance for bitewing x-rays, intraoral x-rays up to 1 set(s) per year.
0% coinsurance for emergency diagnostic exam up to 1 per year.
0% coinsurance for periodic oral exam, prophylaxis (cleaning) up to 2 per year.
0% coinsurance for periodontal maintenance up to 4 per year.
0% coinsurance for necessary anesthesia with covered service up to unlimited per year.
$25 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years.
$25 copayment for scaling for moderate inflammation up to 1 every 3 years.
$25 copayment per tooth for amalgam and/or composite filling up to unlimited per year.
$1,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.
Out of Network
0% coinsurance for comprehensive oral evaluation or periodontal exam up to 1 every 3 years.
0% coinsurance for panoramic film or diagnostic x-rays up to 1 every 5 years.
0% coinsurance for bitewing x-rays, intraoral x-rays up to 1 set(s) per year.
0% coinsurance for emergency diagnostic exam up to 1 per year.
0% coinsurance for periodic oral exam, prophylaxis (cleaning) up to 2 per year.
0% coinsurance for periodontal maintenance up to 4 per year.
0% coinsurance for necessary anesthesia with covered service up to unlimited per year.
$25 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years.
$25 copayment for scaling for moderate inflammation up to 1 every 3 years.
$25 copayment per tooth for amalgam and/or composite filling up to unlimited per year.
$1,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.
Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions.

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage

CoverageDetails
Vision care
Out-of-Network:

Medicare Covered Eye Exams Services:
Copayment for Medicare Covered Eye Exams $0 to $45
Copayment for Medicare Covered Eyewear $0

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Hearing careIn-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $45
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0
  • Maximum 1 visit every year
Prior Authorization Required for Hearing Exams

Hearing Aids:
Copayment for Hearing Aids $0
  • Maximum 2 Hearing Aids every year
Maximum Plan Benefit of $500 every year

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Preventive services and health/wellness education programsIn-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation
    Yearly "Wellness" visit

    When reviewing Florida Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

    You may be able to find plans in your part of Florida that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

    Plan Documents

    Links to plan documents

    Florida Counties Served

    We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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