H5216‑309 Medicare Plan (HumanaChoice Giveback PPO)

H5216‑309 is a Medicare Advantage plan with $0 premium. It puts $123 back in your pocket every month.

This plan helps you save on Medicare Part B costs while covering your health and drug needs.

Quick Facts:

• $0 monthly premium Medicare Advantage PPO plan
• $123 Part B premium giveback credited monthly to Social Security
• Available in Indiana, Ohio and Kentucky counties only
• $0 deductible for prescription drugs
• 3.5 star CMS quality rating for 2026

What Is the H5216‑309 Plan?

H5216‑309 is called HumanaChoice Giveback H5216‑309 (PPO). It is a Medicare Advantage Prescription Drug (MAPD) plan. Humana runs this plan under contract with Medicare.

The plan covers medical care and prescription drugs together. You get one card for all your health needs. The “Giveback” feature means Humana pays part of your Medicare Part B premium.

This plan serves specific counties in three states. You must live in these areas to join.

Plan Basics and Ratings

The official CMS plan ID is H5216‑309‑0. Humana is the largest Medicare Advantage insurer in the United States. This plan has about 28,817 members nationwide as of January 2026.

The CMS gives this plan 3.5 out of 5 stars. This rating sits below the 4‑star quality bonus threshold. The health plan scores 3.5 stars. The drug plan scores 3.0 stars.

If you want to compare similar options, look at H5216‑345. This related plan may offer different benefits for your county.

Where You Can Enroll

You can only join H5216‑309 if you live in specific counties. The plan covers most of Indiana. It also serves some counties in Ohio and Kentucky.

Indiana counties include: Adams, Allen, Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Cass, Clay, Clinton, Dearborn, Decatur, Delaware, Fayette, Floyd, Fountain, Franklin, Grant, Hamilton, Hancock, Harrison, Hendricks, Henry, Howard, Huntington, Jackson, Jay, Jefferson, Jennings, Johnson, Lawrence, Madison, Marion (Indianapolis), Miami, Montgomery, Morgan, Ohio, Orange, Parke, Pike, Posey, Randolph, Ripley, Rush, Scott, Shelby, Starke, Sullivan, Switzerland, Tippecanoe, Union, Vanderburgh, Vermillion, Vigo, Wabash, Warren, Wayne, Wells, and White counties.

Ohio counties include: Adams, Ashtabula, Muskingum, and Summit.

Kentucky counties include: Boone, Campbell, Henderson, Kenton, and Pendleton.

Moving out of these counties triggers a Special Enrollment Period. You must pick a new plan if you move away.

Plan Costs and Savings

H5216‑309 keeps money in your wallet. You pay no premium to Humana. You get money back from Medicare Part B instead.

Monthly Costs and Giveback

You pay $0 per month for this plan. You still pay the standard Medicare Part B premium to the government. That amount is $206.50 in 2026.

Humana gives you back $123 each month. This money comes as a credit on your Social Security check. If you do not get Social Security yet, it reduces your Part B bill.

The health plan has a $425 annual deductible. You must pay this before coverage starts for most non‑preventive care. Prescription drugs have $0 deductible.

Your annual medical costs cannot exceed certain limits. These are your out‑of‑pocket maximums.

Maximum Protection Limits

The plan protects you from huge bills. Once you hit these limits, coverage becomes free.

• In‑network only: $9,150 per year
• In‑network plus out‑of‑network combined: $13,900 per year
• Prescription drugs: $2,100 separate limit

After you pay $2,100 for drugs, your Part D costs drop to $0 for the year.

If you need lower out‑of‑pocket limits, check H5216‑420. That plan might offer different cost-sharing for frequent medical users.

Medical Coverage Details

H5216‑309 covers doctor visits, hospital stays, and tests. You pay different amounts based on where you get care.

In‑Network Benefits

You save the most money with in‑network doctors. These providers contract with Humana for lower rates.

• Primary care visits: $0 copay
• Specialist visits: $40 copay (requires prior approval)
• Urgent care: $40 copay
• Emergency room: $115 copay
• Hospital stay: $400 per day for days 1‑5, then $0 for days 6‑90
• Outpatient hospital: $0 to $400 per visit
• Lab tests: $0 to $40 copay
• X‑rays and scans: $0 to $780 copay
• Physical therapy: $20 to $35 copay
• Mental health visits: $35 copay outpatient
• Ambulance: $335 copay

Important: Most services need prior authorization. You must get approval before seeing specialists. You need approval for hospital stays, tests, and therapy. Call Humana first or they may not pay.

Out‑of‑Network Rules

This plan is a PPO. However, it acts like an HMO for many services. Many out‑of‑network benefits show as “not covered.”

• Primary care: 30% coinsurance (or not covered)
• Specialists: Not covered or 30% coinsurance
• Hospital: 50% coinsurance per stay
• Outpatient hospital: Not covered
• Preventive care: Not covered

Emergency care works anywhere in the world. Routine care does not work outside the network.

For plans with better travel coverage, view H5216‑405. It may offer broader out‑of‑network benefits.

Prescription Drug Coverage

H5216‑309 includes Part D drug coverage. You do not need a separate drug plan.

Drug Costs and Tiers

The plan uses five drug tiers. Each tier has different costs.

Insulin costs: Part D insulins cost no more than $35 per month. Some require prior authorization.

The plan uses the Humana Medicare formulary. Check Medicare.gov to verify your specific medications. This official source lists all covered drugs and restrictions.

Extra Benefits Included

H5216‑309 adds benefits that Original Medicare does not cover. These include dental, vision, and hearing.

Dental, Vision, and Hearing

Dental:

• Cleanings and exams: $0 copay (up to $500 yearly limit)
• Fillings: $25 copay
• Major work: Not covered (crowns, root canals, dentures)
• Optional upgrade: $48 per month for $1,000 annual dental benefit

Vision:

• Eye exams: $0 to $40 copay
• Glasses: $0 copay (limits apply)
• Contacts: $0 copay (limits apply)
• Prior authorization required for exams

Hearing:

• Hearing test: $40 copay
• Hearing aids: $699 to $999 per aid
• Covers 2 aids per year
• Fitting included at no cost

Other Perks

The plan offers worldwide emergency coverage. It covers wigs for cancer patients at $0 cost.

You may get short‑term meal delivery after hospital stays. Some members get fitness benefits like gym access.

Over‑the‑counter (OTC) benefits vary by location. Check with Humana to see if your county includes the $50 quarterly OTC allowance.

Who Should Enroll?

H5216‑309 fits some people better than others. Review your health needs before joining.

Ideal Members

This plan works best for healthy seniors on fixed incomes. The $123 monthly giveback saves you $1,476 per year.

This helps if you take generic drugs that cost $0. It suits people who stay in‑network for care. Indiana residents have the best network access.

Warning Signs

Avoid this plan if you see specialists often. The prior authorization rules create delays. The $9,150 in‑network maximum is high for sick members.

If you travel often, the lack of out‑of‑network coverage hurts you. Major dental work requires buying extra coverage.

The 3.5-star rating shows room for quality improvement. State averages run higher (Ohio 3.9, Kentucky 3.7).

How to Sign Up

You can enroll during specific Medicare periods. Act during these windows to secure coverage.

Enrollment Windows

• Initial Enrollment: 7 months around your 65th birthday
• Annual Enrollment: October 15 to December 7 (starts January 1)
• Medicare Advantage Open Enrollment: January 1 to March 31 (switch plans only)
• Special Enrollment: Move, lose other coverage, or qualify for Extra Help

Contact Information

New Members: 1‑888‑873‑0686
Current Members: 1‑800‑457‑4708
TTY: 711
Website: www.humana.com/medicare
Mail: 101 E Main Street, Louisville, KY 40202

Verify all details on CMS.gov before enrolling. This government site confirms current star ratings and plan availability.

Frequently Asked Questions