Humana Direct Choice Giveback (PPO) 2026 Plan Details for Suffolk County, Massachusetts Residents
Humana Direct Choice Giveback (PPO) 2026 Plan Details for Suffolk County, Massachusetts Residents
Navigating your Medicare Advantage options in Suffolk County for 2026 can be overwhelming, but we're here to help. With Humana Direct Choice Giveback (PPO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
The latest CMS enrollment data shows an estimated 367 Medicare beneficiaries are enrolled in this plan, with 69 members in Suffolk County, MA.
Humana Direct Choice Giveback Overview
| Plan ID H5216-424-0 Overview | |
|---|---|
| Health Plan ID: | H5216-424-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $475 |
| Annual Out-of-Pocket Maximum: | $5200.00 (In-Network) |
| Part B Give Back: | −$60.00 reduction |
| Part D Drug Plan Benefit: | Enhanced, $395.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Suffolk County, MA |
| Insured By: | Humana |
Why Consider Humana Direct Choice Giveback?
This Medicare Advantage MAPD PPO plan combines full coverage with the flexibility to choose your providers. With a monthly premium of $0.00, it includes all standard Medicare Part A and Part B benefits, plus built-in prescription drug coverage. The annual Part D deductible is $395.00. You can visit any Medicare-approved provider — in or out of network — with lower costs when using in-network services.
Primary care visits have a $0 copay | Out-of-network: $45 copay, and specialist visits come with a $40 copay | Out-of-network: $65 copay. Urgent care services carry a $50 copay, and ground ambulance transportation is $315 copay | Out-of-network: $315 copay. These costs apply toward your maximum out-of-pocket (MOOP) limit of $5200.00. Once that limit is reached, your in-network care is fully covered for the rest of the year.
You’ll find this plan listed by CMS as H5216-424-0. Cost-sharing details are outlined below. Still have questions? Check the FAQ section for more information.
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Out-of-Pocket Expenses
Humana Direct Choice Giveback has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5216-424-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $45 copay |
| Specialist: | In-network: $40 copay | Out-of-network: $65 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$50 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | Not covered |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over the counter drug benefits: | Not covered |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: $0 copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $130 copay |
| Wordwide emergency care: | $130 copay |
| Urgent care: | $50 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $445 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | $445 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $10 per day for days 1-20 | $218 per day for days 21-100 | Out-of-network: | 40% per stay |
| Ground ambulance: | In-network: $315 copay | Out-of-network: $315 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $35 copay | Out-of-network: 40% coinsurance |
| Outpatient group therapy: | In-network: $35 copay | Out-of-network: 40% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $445 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | $445 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $40 copay | Out-of-network: 35%-40% coinsurance |
| Occupational therapy: | In-network: $40 copay | Out-of-network: 35%-40% coinsurance |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay, 10%-20% coinsurance | Out-of-network: 40% coinsurance |
| Durable medical equipment: | In-network: $0 copay, 20% coinsurance | Out-of-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0-$780 copay | Out-of-network: $0 copay, 40% coinsurance |
| Lab services: | In-network: $0-$50 copay | Out-of-network: $45-$65 copay, 40% coinsurance |
| Outpatient x-rays: | In-network: $0-$130 copay | Out-of-network: $45-$65 copay, 40% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$100 copay | Out-of-network: $45-$65 copay, 40% coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay |
| Periodontics: | In-network: $0 copay | Out-of-network: $0 copay |
| Endodontics: | In-network: $0 copay | Out-of-network: $0 copay |
| Restorative services: | In-network: $0 copay, 30%-40% coinsurance | Out-of-network: $0 copay, 30%-40% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $0 copay |
| Prescription hearing aids: | In-network: $699-$999 copay | Out-of-network: $699-$999 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Humana Direct Choice Giveback as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Humana Direct Choice Giveback includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $-24.60 |
|---|---|
| Supplemental Part D Premium: | $24.60 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $35.76 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $395.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Humana starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Humana Direct Choice Giveback may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $1.00 copay | Coming soon |
| Preferred Brand | $47.00 copay | Coming soon |
| Non-Preferred Drug | 48% coinsurance | Coming soon |
| Specialty Tier | 28% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Humana Direct Choice Giveback?
To qualify for enrollment in Humana Direct Choice Giveback, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Humana Direct Choice Giveback and enjoy the extensive healthcare benefits it offers.
Enrollment Periods for Humana Direct Choice Giveback
Knowing when you can enroll in Humana Direct Choice Giveback is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Sign Up for Humana Direct Choice Giveback
Joining Humana Direct Choice Giveback is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join Humana Direct Choice Giveback.
- Direct Enrollment: You can also choose to enroll directly with Humana Direct Choice Giveback. The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Here are some of the most frequently asked questions people have about plan ID H5216-424-0:
How much does H5216-424-0 cost per month?
For 2026, the monthly premium is $0.00, and you still pay your Part B premium to Medicare.
How high can my costs go in a worst-case year?
The annual in-network MOOP is $5200.00, protecting you from larger bills once you hit that limit.
Is there a Part D deductible with this plan?
You’ll pay the first $395.00 in drug costs before coinsurance kicks in.
What’s the CMS star score for Humana Direct Choice Giveback?
For 2026, plan H5216-424-0 has a ★3.5 rating. The best rating is 5 stars.
Is Humana Direct Choice Giveback popular?
Enrollment stands at roughly 367 members.
Contact Humana
| Contact Type | Details |
|---|---|
| Website: | Humana Plan Page |
| New Members: | 1-888-873-0686 |
| Existing Members: | 1-800-457-4708 |
| Plan Address: | 101 E Main Street | Louisville, KY 40202 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Humana, http://www.humana.com/medicare — Last accessed October 13, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
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Page content managed by David Bynon, Medicare Analyst.
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