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Humana USAA Honor Giveback (PPO)

Humana Inc.
Humana USAA Honor Giveback (PPO) H5216-278 Plan Details
3.5 out of 5 stars

Humana USAA Honor Giveback (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-278

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Humana USAA Honor Giveback (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-278

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Humana Inc.
Humana USAA Honor Giveback (PPO) H5216-278 Plan Details
3.5 out of 5 stars

Humana USAA Honor Giveback (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H5216-278

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Iowa Counties Served

Burt Audubon Calhoun Carroll Van Buren Louisa Harrison Dickinson Lyon Cherokee Sioux Ida Adams Sac Buena Vista Pocahontas Webster Emmet Hardin Jasper Hamilton Adair Dallas Warren Cass Nemaha Marshall Guthrie Franklin Polk Wayne Story Monroe Marion Ringgold Union Boone Madison Shelby Mahaska Wright Greene Lucas Decatur Poweshiek Keokuk Tama Clarke Iowa Grundy Cerro Gordo Hancock Winnebago Mitchell Palo Alto Kossuth Worth Floyd Butler Howard Clay Humboldt Chickasaw Buchanan Fayette Benton Delaware Monona Black Hawk Bremer Montgomery Page Plymouth Crawford Woodbury Obrien Osceola Pottawattamie Mills Fremont Jackson Jones Clinton Winneshiek Atchison Allamakee Washington Linn Johnson Cedar Wapello Jefferson Davis Henry Appanoose Des Moines Lee Scott Muscatine

Minnesota Counties Served

Dodge Freeborn Mower Blue Earth Winona Nicollet Brown Sibley Waseca Rice Steele Goodhue Faribault Martin Fillmore Houston Deuel Washington Wabasha Pine Kanabec Dakota Hennepin Isanti Anoka Scott Carver Mille Lacs Ramsey Wright Mcleod Renville Meeker Benton Lake Saint Louis Carlton Itasca Aitkin Koochiching Cass Le Sueur Nobles Lincoln Lyon Rock Pipestone Brookings Big Stone Lac Qui Parle Otter Tail Morrison Todd Crow Wing Wadena Hubbard Becker Clay Mahnomen Wilkin Norman Red Lake Polk Clearwater Beltrami Lake of the Woods Roseau Pennington Marshall Kittson

Montana Counties Served

Lincoln Mckenzie Pondera Judith Basin Teton Chouteau Cascade Rosebud Carbon Silver Bow Ravalli Flathead Park Stillwater Yellowstone Big Horn Meagher Treasure Musselshell Gallatin Sweet Grass Fergus Wheatland Golden Valley Beaverhead Idaho Lewis and Clark Glacier Toole Liberty Jefferson Broadwater Powell Missoula Sanders Madison Divide Deer Lodge Granite Mineral Lake

North Dakota Counties Served

Burleigh Cass Richland Grand Forks Stutsman Morton

South Dakota Counties Served

Yankton Hanson Davison Union Pennington Keya Paha Meade Butte Sargent Lawrence Fall River Custer Lincoln Clay Mccook Hutchinson Miner Moody Crook Carter Brookings Minnehaha Turner Lake Kingsbury Richland Emmons Codington Hamlin Deuel Day Marshall Roberts Grant Mcintosh Clark Spink Sanborn

Nebraska Counties Served

Cass Washington Butler Dodge Saunders Lancaster Jefferson Thurston Wayne Burt Douglas Decatur Cuming Rawlins Sarpy Seward Gregory Platte Thayer York Saline Polk Fillmore Colfax Dixon Dakota

Wyoming Counties Served

Teton Uinta Lincoln Weston Goshen Caribou Park Laramie Crook Albany

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $-1
Out of Pocket Max In-Network: $6700
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Out-of-Network:

Doctor Office Visit Services:
Coinsurance for Medicare Covered Primary Care Office Visit 50%
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $35
Out-of-Network:

Doctor Specialty Visit Services:
Coinsurance for Medicare Covered Physician Specialist Office Visit 50%
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$380 per day for days 1 to 6
$0 per day for days 7 to 90
Prior Authorization Required for Acute Hospital Services
Prior authorization required
Out-of-Network:

Acute Hospital Services:
Coinsurance for Acute Hospital Services per Stay 50%
Urgent Care
Copayment for Urgent Care $55

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $125
Emergency Room Visit
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
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $315

Air Ambulance:
Copayment for Air Ambulance Services $1250
Prior Authorization Required for Air Ambulance
Prior authorization required
Out-of-Network:

Ambulance Services:
Copayment for Medicare Covered Ambulance Services - Ground $315
Copayment for Medicare Covered Ambulance Services - Air $1250

Health Care Services and Medical Supplies

Humana USAA Honor Giveback (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Copayment for Medicare-covered Chiropractic Services $15
Prior Authorization Required for Chiropractic Services
Prior authorization required
Out-of-Network:

Medicare Covered Chiropractic Services:
Coinsurance for Medicare Covered Chiropractic Services 50%
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Copayment for Medicare-covered Diabetic Supplies $0
Coinsurance for Medicare-covered Diabetic Supplies 10% to 20%
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0
Out-of-Network:

Medicare Covered Diabetic Supplies and Services:
Coinsurance for Medicare Covered Diabetic Supplies 50%
Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 50%
Durable Medical Eqipment (DME)
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 15%
Prior Authorization Required for Durable Medical Equipment
Prior authorization required
Out-of-Network:

Medicare Covered Durable Medical Equipment Services:
Coinsurance for Medicare Covered Durable Medical Equipment 50%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $55
Copayment for Medicare-covered Lab Services $0 to $55
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
$50 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$35 OP Diag Proc & Tests - SPC$55 OP Diag Proc & Tests - UCC$50 Sleep Study (Fac Based) - OPH$35 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 $380
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Copayment for Medicare-covered X-Ray Services $0 to $150
Prior authorization required
Out-of-Network:

Medicare Covered Diagnostic Procedures/Tests Services:
Coinsurance for Medicare Covered Diagnostic Procedures/Tests
50%
Coinsurance for Medicare Covered Lab Services
50%
Coinsurance for Medicare Covered Diagnostic Radiological Services 50%
Coinsurance for Medicare Covered Therapeutic Radiological Services 50%
Coinsurance for Medicare Covered Outpatient X-Ray Services 50%
$50 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$35 OP Diag Proc & Tests - SPC$55 OP Diag Proc & Tests - UCC$50 Sleep Study (Fac Based) - OPH$35 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home_
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Prior authorization required
Out-of-Network:

Medicare Covered Home Health Services:
Coinsurance for Medicare Covered Home Health 50%
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$380 per day for days 1 to 6
$0 per day for days 7 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Out-of-Network:

Psychiatric Hospital Services:
Coinsurance for Psychiatric Hospital per Stay 50%
Mental Health Outpatient Care
In-Network:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Out-of-Network:

Medicare Covered Mental Health Services:
Coinsurance for Medicare Covered Individual Sessions 50%
Coinsurance for Medicare Covered Group Sessions 50%
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0 to $380
Prior Authorization Required for Outpatient Hospital Services
$0 Diag Colonoscopy - OPH$50 Mental Health - OPH$380 Surgery Svcs - OPH$45 Wound Care - OPH_

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $380
Prior Authorization Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0 to $300
Prior Authorization Required for Ambulatory Surgical Center Services
$0 Diag Colonoscopy - ASC$300 Surgery Svcs - ASC_
Prior authorization required
Out-of-Network:

Medicare Covered Outpatient Hospital Services:
Coinsurance for Medicare Covered Outpatient Hospital Services 50%
Coinsurance for Medicare Covered Ambulatory Surgical Center Services 50%
$0 Diag Colonoscopy - OPH$50 Mental Health - OPH$380 Surgery Svcs - OPH$45 Wound Care - OPH_
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $40 to $50
Copayment for Medicare-covered Group Sessions $40 to $50
Prior Authorization Required for Outpatient Substance Abuse Services
$50 OP Substance Abuse Care - OPH$40 OP Substance Abuse Care - SPC_
Prior authorization required
Out-of-Network:

Medicare Covered Outpatient Substance Abuse Services:
Coinsurance for Medicare Covered Individual Sessions 50%
Coinsurance for Medicare Covered Group Sessions 50%
$50 OP Substance Abuse Care - OPH$40 OP Substance Abuse Care - SPC_
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $35
Prior Authorization Required for Podiatry Services
Prior authorization required
Out-of-Network:

Medicare Covered Podiatry Services:
Coinsurance for Medicare Covered Podiatry Services 50%
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0 per day for days 1 to 20
$214 per day for days 21 to 70
$0 per day for days 71 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Prior authorization required

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
Plan covers up to $2,000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire.
Your benefit can be used for most dental treatments such as:
Preventive dental services, such as exams, routine cleanings, etc.
Basic dental services, such as fillings, extractions, etc.
Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc.
Note: The allowance cannot be used on fluoride, cosmetic services and implants.
Out of Network
Plan covers up to $2,000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire.
Your benefit can be used for most dental treatments such as:
Preventive dental services, such as exams, routine cleanings, etc.
Basic dental services, such as fillings, extractions, etc.
Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc.
Note: The allowance cannot be used on fluoride, cosmetic services and implants.
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 from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0 to $35
Copayment for Routine Eye Exams $0
  • Maximum 1 Routine Eye Exam every year
Maximum Plan Benefit of $75 every year

Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0
  • Maximum 1 Pair every year
Copayment for Eyeglasses (lenses and frames) $0
  • Maximum 1 Pair every year
Maximum Plan Benefit of $250 every year
Members must use Humana's Medicare Insight Network, a national network of providers, which includes standard or PLUS providers. The allowance for the standard network is $50 less than the PLUS network.
Out-of-Network:

Medicare Covered Eye Exams Services:
Coinsurance for Medicare Covered Eye Exams 50%
Coinsurance for Medicare Covered Eyewear 50%

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $35
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0
Prior Authorization Required for Hearing Exams

Hearing Aids:
Copayment for Hearing Aids $699 to $999
  • Maximum 2 Hearing Aids every year

Prior authorization required
Out-of-Network:

Medicare Covered Hearing Exams Services:
Coinsurance for Medicare Covered Hearing Exams 50%

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-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
    Out-of-Network:

    Medicare Covered Medicare-covered Preventive Services:
    Copayment for Medicare Covered Medicare-covered Preventive Services $0
    Coinsurance for Medicare Covered Medicare-covered Preventive Services 50%
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