Humana USAA Honor Giveback (PPO)

3.5 out of 5 stars
$0.00
Monthly Premium

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

Plan ID: H5216-442

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) - H5216-442 by Humana Inc. as well as other Medicare Advantage plans available in your area.

$0.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $-1
Out of Pocket Max In-Network: $9150
Out-of-Network: 13900
Initial Coverage Limit $0
Catastrophic Coverage Limit $2100
Primary Care Doctor Visit

Out-of-Network:

Doctor Office Visit Services:
Coinsurance for Medicare Covered Primary Care Office Visit $30%
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $45
Prior Authorization Required for Doctor Specialty Visit
Inpatient Hospital Care

Out-of-Network:

Acute Hospital Services:
Coinsurance for Acute Hospital Services per Stay 50%
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
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $335

Air Ambulance:
Copayment for Air Ambulance Services $335
Prior Authorization Required for Air Ambulance

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

Out-of-Network:

Chiropractic Services:
Coinsurance for Medicare Covered Chiropractic Services 30%
In-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:

Diabetic Supplies and Services:
Coinsurance for Medicare Covered Diabetic Supplies 50%
Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 50%
Durable Medical Equipment (DME)
In-Network:

Durable Medical Equipment:
Copayment for Medicare-covered Durable Medical Equipment $0
Coinsurance for Medicare-covered Durable Medical Equipment 16%
Prior Authorization Required for Durable Medical Equipment
$0 Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy16% DME - DME Prov16% DME - Pharmacy
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 $50
Copayment for Medicare-covered Lab Services $0 to $40
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
$50 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$45 OP Diag Proc & Tests - SPC$40 OP Diag Proc & Tests - UCC$50 Sleep Study (Fac Based) - OPH$45 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 $780
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 $130
Home Health Care
In-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$500 per day for days 1 to 3
$0 per day for days 4 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 30%
Coinsurance for Medicare Covered Group Sessions 30%
Outpatient Services / Surgery

Out-of-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0
Coinsurance for Medicare Covered Outpatient Hospital Services 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$595 Surgery Svcs - OPH$50 Wound Care - OPH
Outpatient Substance Abuse Care

Out-of-Network:

Outpatient Substance Abuse Services:
Coinsurance for Medicare Covered Individual Sessions 30% to 50%
Coinsurance for Medicare Covered Group Sessions 30% 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
Over-the-counter (OTC) Items
Over-the-Counter: $25 quarterly allowance on a prepaid spending card to buy approved over-the-counter health and wellness products at participating retail locations or through the plan's approved OTC mail order vendor.
Unused amount expires at the end of the quarter.
Podiatry Services
In-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $35
Prior Authorization Required for Podiatry Services

Out-of-Network:

Podiatry Services:
Coinsurance for Medicare Covered Podiatry Services 30%
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.
$25 copayment per tooth for amalgam and/or composite filling up to 2 per year.
$1,000 combined maximum benefit coverage amount per year for preventive and comprehensive benefits.

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 $45
Copayment for Routine Eye Exams $0
  • Maximum 1 Routine Eye Exams every year
Prior Authorization Required for Eye Exams
$0 Diab Eye Exam - All POTs$45 Vision Svcs (MC) - SPC

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 $100 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.

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 30%

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

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