Last Updated: January, 2026
Sources: Medicare.gov, Humana 2026 Summary of Benefits, CMS.gov
The HumanaChoice Giveback H5216-345 (PPO) is a popular Medicare Advantage plan for 2026.
It is known for its “Giveback” feature that puts money back into your Social Security check.
This plan is available to residents in select counties of Georgia and South Carolina.
Quick Article Summary:
- $130 Part B Giveback: Reduces your monthly Medicare Part B premium cost.
- $0 Monthly Premium: You pay nothing to the insurance company each month.
- Prescription Drug Coverage: Includes a Part D plan with a $2,100 out-of-pocket cap.
- PPO Flexibility: See any doctor who accepts Medicare, even out-of-network.
- Extra Benefits: Covers dental, vision, hearing, and fitness programs.
Understanding the $130 Part B Giveback
The “Giveback” is the most popular part of the H5216-345 plan. In 2026, the standard Medicare Part B premium is $202.90.
If you enroll in this plan, Humana pays up to $130 of that premium for you. This means your Social Security check increases by $130 every month. This is a great way for seniors on a fixed income to save over $1,500 per year.
2026 Financial Costs for H5216-345
While the premium is $0, there are other costs to keep in mind for this Local PPO plan.
| Category | 2026 Plan Cost |
|---|---|
| Monthly Plan Premium | $0.00 |
| Part B Premium Reduction | Up to $130.00 monthly |
| Medical Deductible | $500 (In/Out-of-Network combined) |
| In-Network Max Out-of-Pocket | $9,250 |
| Combined Max Out-of-Pocket | $13,900 |
Note: The $9,250 limit is your “safety net.” Once you spend this much on medical care, the plan pays 100% for the rest of the year.
Medical Coverage & Copays
This PPO plan allows you to visit specialists without a referral. You pay less if you stay in the Humana network.
- Primary Care Visit: $0 copay (In-network).
- Specialist Visit: $40 copay (In-network).
- Inpatient Hospital Stay: $360 per day for days 1–7; $0 for days 8–90.
- Emergency Room: $115 copay (waived if admitted).
- Lab Services: $0 to $50 copay depending on the location.
2026 Prescription Drug (Part D) Benefits
Thanks to the Inflation Reduction Act, all Medicare Advantage plans now have a $2,100 annual cap on out-of-pocket drug costs for 2026.
Drug Deductible: $450 (Only applies to Tiers 3, 4, and 5).
Preferred Generic (Tier 1): $0 copay at preferred pharmacies.
Supplemental “Extra” Benefits
Humana Choice Giveback H5216-345 includes more than just basic medical care:
- Dental: $0 copay for exams and cleanings; includes comprehensive coverage limits.
- Vision: $0 routine exams and a $150 allowance for glasses or contacts.
- Hearing: $0 routine exams; copays for hearing aids between $699 and $999.
- Fitness: Access to the SilverSneakers program at no extra cost.
Frequently Asked Questions (FAQ)
1. Is the H5216-345 plan available in my county?
This plan is specifically for select counties in Georgia and South Carolina. You should verify your specific ZIP code on the Humana website or Medicare.gov to ensure it is offered in your city for the 2026 plan year.
2. How do I get the $130 Part B Giveback?
You do not need to file a claim. Once you enroll in the H5216-345 plan, Humana notifies Medicare. The $130 reduction is applied automatically to your Social Security check. It may take 1-3 months for the change to appear.
3. Do I need a referral to see a specialist? No
. Because this is a PPO (Preferred Provider Organization), you do not need a referral from a primary care doctor. You can book an appointment directly with a specialist, though using in-network doctors will save you money.
4. What happens if I go out-of-network?
You can see any doctor who accepts Medicare and agrees to bill Humana. However, you will likely pay a 25% to 50% coinsurance instead of a flat copay. This will make your visits more expensive.
5. Does this plan cover dental implants?
Standard Medicare Advantage plans typically cover routine and some basic comprehensive dental (like fillings). Large procedures like implants are usually not fully covered. Check the 2026 Evidence of Coverage for specific dental limits.
6. What is the Medicare Part D out-of-pocket cap for 2026?
For the 2026 plan year, the maximum you will pay out-of-pocket for covered prescription drugs is $2,100. Once you reach this limit, you pay $0 for your covered medications for the remainder of the year.
CONCLUSION: Is the H5216-345 Plan Right for You?
The HumanaChoice Giveback H5216-345 (PPO) is a strong option for seniors in Georgia and South Carolina who want to lower their monthly costs. With a $130 Part B Giveback and a $0 monthly premium, it provides significant savings that go directly back into your pocket.
While the $9,250 out-of-pocket maximum is higher than some other plans, the flexibility of a PPO and the comprehensive drug coverage make it a balanced choice. Before you enroll, always check your local ZIP code and confirm your specific doctors are in-network to get the best value.
