Humana USAA Honor Giveback (PPO)

3.5 out of 5 stars

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Humana USAA Honor Giveback (PPO) is a PPO plan offered by Humana Inc.

Plan ID: H5216-310

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.

Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as Humana USAA Honor Giveback (PPO) - H5216-310 by Humana Inc. as well as other Medicare Advantage plans available in your area.

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Virginia Counties Served

Accomack Albemarle Alexandria City Alleghany Amelia Amherst Appomattox Arlington Augusta Bath Bedford Bland Botetourt Brunswick Buckingham Buena Vista City Campbell Caroline Carroll Charles City Charlotte Charlottesville City Chesapeake City Chesterfield Clarke Colonial Heights City Covington City Craig Culpeper Cumberland Danville City Dinwiddie Emporia City Essex Fairfax City Falls Church City Fauquier Floyd Fluvanna Franklin Franklin City Frederick Fredericksburg City Galax City Giles Gloucester Goochland Greene Greensville Halifax Hampton City Hanover Harrisonburg City Henrico Henry Highland Hopewell City Isle Of Wight James City Jefferson King And Queen King George King William Lancaster Lexington City Louisa Lunenburg Lynchburg City Madison Manassas City Manassas Park City Martinsville City Mathews Mecklenburg Middlesex Montgomery Nelson New Kent Newport News City Norfolk City Northampton Northumberland Nottoway Orange Page Patrick Petersburg City Pittsylvania Poquoson City Portsmouth City Powhatan Prince Edward Prince George Prince William Pulaski Radford Rappahannock Richmond Richmond City Roanoke Roanoke City Rockbridge Rockingham Salem Shenandoah Southampton Spotsylvania Stafford Staunton City Suffolk City Surry Sussex Virginia Beach City Warren Waynesboro City Westmoreland Williamsburg City Winchester City York

Basic Costs and Coverage

Coverage	Cost
Monthly Deductible	$-1
Out of Pocket Max	In-Network: $8700 Out-of-Network: 13900
Initial Coverage Limit	$0
Catastrophic Coverage Limit	$2100
Primary Care Doctor Visit	In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0
Specialty Doctor Visit	Out-of-Network: Doctor Specialty Visit Services: Coinsurance for Medicare Covered Physician Specialist Office Visit $35%
Inpatient Hospital Care	In-Network: Acute Hospital Services: $375 per day for days 1 to 7 $0 per day for days 8 to 90 Prior Authorization Required for Acute Hospital Services
Urgent Care	Urgent Care: Copayment for Urgent Care $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $115
Emergency Room Visit	Emergency Care: Copayment for Emergency Care $115 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 $115 Copayment for Worldwide Emergency Transportation $115
Ambulance Transportation	Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $335 Copayment for Medicare Covered Ambulance Services - Air $335

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: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 Prior Authorization Required for Chiropractic Services Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 35% In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 Prior Authorization Required for Chiropractic Services Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 35%
Diabetes Supplies, Training, Nutrition Therapy and Monitoring	In-Network: Diabetic Supplies and Services: 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 $10
Durable Medical Equipment (DME)	Out-of-Network: Durable Medical Equipment Services: Copayment for Medicare Covered Durable Medical Equipment $0 Coinsurance for Medicare Covered Durable Medical Equipment 20% $0 Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy20% DME - DME Prov20% DME - Pharmacy
Diagnostic Tests, Lab and Radiology Services, and X-Rays	Out-of-Network: Diagnostic Procedures/Tests Services: Coinsurance for Medicare Covered Diagnostic Procedures/Tests 35% to 50% Coinsurance for Medicare Covered Lab Services 50% Copayment for Medicare Covered Diagnostic Radiological Services $0 Coinsurance for Medicare Covered Diagnostic Radiological Services 50% Coinsurance for Medicare Covered Therapeutic Radiological Services 35% to 50% Coinsurance for Medicare Covered Outpatient X-Ray Services 35% to 50% $120 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$40 OP Diag Proc & Tests - SPC$40 OP Diag Proc & Tests - UCC$120 Sleep Study (Fac Based) - OPH$40 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home
Home Health Care	Out-of-Network: Home Health Services: Coinsurance for Medicare Covered Home Health 50%
Mental Health Inpatient Care	In-Network: Psychiatric Hospital Services: $375 per day for days 1 to 5 $0 per day for days 6 to 90 Prior Authorization Required for Psychiatric Hospital Services
Mental Health Outpatient Care	Out-of-Network: Mental Health Services: Coinsurance for Medicare Covered Individual Sessions 35% Coinsurance for Medicare Covered Group Sessions 35%
Outpatient Services / Surgery	Out-of-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 Coinsurance for Medicare Covered Outpatient Hospital Services 35% to 50% Copayment for Medicare Covered Ambulatory Surgical Center Services $0 Coinsurance for Medicare Covered Ambulatory Surgical Center Services 50% $0 Diag Colonoscopy - OPH$0 Mental Health - OPH$450 Surgery Svcs - OPH$40 Wound Care - OPH
Outpatient Substance Abuse Care	Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 35% to 50% Coinsurance for Medicare Covered Group Sessions 35% to 50% In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 Prior Authorization Required for Outpatient Substance Abuse Services In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 Prior Authorization Required for Outpatient Substance Abuse Services Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 35% to 50% Coinsurance for Medicare Covered Group Sessions 35% to 50%
Over-the-counter (OTC) Items
Podiatry Services	Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 35% In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $40 Prior Authorization Required for Podiatry Services Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 35% In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $40 Prior Authorization Required for Podiatry Services
Skilled Nursing Facility Care	Out-of-Network: Skilled Nursing Facility Services: Coinsurance for Skilled Nursing Facility per Stay 50%

Dental Benefits

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

Coverage	Cost
Dental Care	$0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for necessary anesthesia with covered service up to as needed with covered codes per year. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions.

Coverage

Cost

Dental Care

$0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years.
$0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years.
$0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year.
$0 copayment for emergency diagnostic exam up to 1 per year.
$0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year.
$0 copayment for periodontal maintenance up to 4 per year.
$0 copayment for necessary anesthesia with covered service up to as needed with covered codes per year.
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	Out-of-Network: Eye Exams Services: Copayment for Medicare Covered Eye Exams $0 Coinsurance for Medicare Covered Eye Exams 35% Copayment for Medicare Covered Eyewear $0 $0 Diab Eye Exam - All POTs$40 Vision Svcs (MC) - SPC

Hearing Benefits

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

Coverage	Cost
Hearing Benefits	Out-of-Network: Hearing Exams Services: Coinsurance for Medicare Covered Hearing Exams 35%

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	Out-of-Network: Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0

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