HumanaChoice Giveback H5216-445 (PPO) 2025 Plan Details for Torrance County, New Mexico Residents
HumanaChoice Giveback H5216-445 (PPO) 2025 Plan Details for Torrance County, New Mexico Residents
Navigating your Medicare Advantage options in Torrance County for 2025 can be overwhelming, but we're here to help. With HumanaChoice Giveback H5216-445 (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.
Based on May, 2025 CMS enrollment data, an estimated 78 Medicare beneficiaries are enrolled in this plan, with 0 members in Torrance County, NM.
HumanaChoice Giveback H5216-445 Overview
| Plan ID H5216-445-0 Overview | |
|---|---|
| Health Plan ID: | H5216-445-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $1,000.00 |
| Annual Out-of-Pocket Maximum: | $7,850.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $70.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Torrance County, NM |
| Insured By: | Humana |
Explore the Benefits of HumanaChoice Giveback H5216-445
This MAPD PPO Medicare Advantage plan offers broad coverage with the freedom to choose your providers. With a monthly premium of $0.00, it includes all core benefits under Medicare Part A and Part B, plus prescription drug coverage to manage ongoing medications. The annual Part D deductible is $70.00. You can see any Medicare-approved provider — in or out of network — though in-network care typically costs less.
Primary care visits have a $20 copay, and specialist visits come with a $55 copay. Urgent care services carry a 20% coinsurance, and ground ambulance transportation is $315 copay. These costs all count toward your annual maximum out-of-pocket (MOOP) limit of $7,850.00 . After that limit is reached, all in-network care is fully covered through the end of the year.
CMS recognizes this plan as H5216-445-0. A detailed breakdown of cost sharing is available below. Still have questions? Check the FAQ section for more insights.
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Out-of-Pocket Expenses
HumanaChoice Giveback H5216-445 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 H5216-445-0.
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: | $20 Copay |
| Specialist: | $55 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: | $110 Copay |
| Urgent care: | 20% Coinsurance |
| Ground ambulance: | $315 Copay |
| Inpatient hospital care: | $370.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $55 Copay Prior Authorization Required |
| Routine Foot Care: | $55 Copay Prior Authorization Required |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $15 Copay Prior Authorization Required |
| Routine chiropractic: | Not Covered |
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: | $20 Copay |
| Outpatient group therapy: | $20 Copay |
| Inpatient psychiatric hospital care: | $370.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
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: | 20% Coinsurance Prior Authorization Required |
| Occupational therapy: | 20% Coinsurance Prior Authorization Required |
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: | 20% Coinsurance Prior Authorization Required |
| Durable medical equipment: | 12% Coinsurance Prior Authorization Required |
| Prosthetics: | 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: | 20% Coinsurance Prior Authorization Required |
| Lab services: | 20% Coinsurance Prior Authorization Required |
| Outpatient x-rays: | 20% Coinsurance Prior Authorization Required |
| Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 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) |
|---|---|
| Medicare Covered Preventive Dental | $55 Copay Prior Authorization Required |
| Oral exam | $0 Copay |
| Dental x-rays | $0 Copay |
| Cleaning | $0 Copay |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay Prior Authorization Required, Limitations Apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay Prior Authorization Required |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $55 Copay |
| Routine eye exam (in-network) | $0 Copay Prior Authorization Required, 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $250.00 Every year |
Certain preventive services are covered 100% by HumanaChoice Giveback H5216-445 as a Part B benefit.
Part D Prescription Drug Costs & Benefits
HumanaChoice Giveback H5216-445 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: | $(34.30) |
|---|---|
| Supplemental Part D Premium: | $34.30 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| 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 $70.00 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, HumanaChoice Giveback H5216-445 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 | $10.00 |
| Generic* | $5.00 | $20.00 |
| Preferred Brand | $45.00 | $47.00 |
| Non-Preferred Drug | 49.00% | 49.00% |
| Specialty Tier | 32.00% | 32.00% |
| *Deductible does not apply. | ||
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2025 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.
Eligibility Requirements for HumanaChoice Giveback H5216-445
You are eligible to enroll in HumanaChoice Giveback H5216-445 if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for HumanaChoice Giveback H5216-445 and take advantage of its full range of benefits.
When Can I Enroll in HumanaChoice Giveback H5216-445 ?
Understanding the right time to enroll in HumanaChoice Giveback H5216-445 is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
How to Enroll in HumanaChoice Giveback H5216-445
Joining HumanaChoice Giveback H5216-445 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 HumanaChoice Giveback H5216-445 .
- Direct Enrollment: You can also choose to enroll directly with HumanaChoice Giveback H5216-445 . 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 H5216-445-0:
Is there a premium for this plan in 2025?
The 2025 premium is $0.00 each month, and you must continue to pay your Part B premium.
What is the annual out-of-pocket maximum on this plan?
For 2025, the maximum you’d spend out-of-pocket in-network is $7,850.00 .
How much do I pay before drug coverage starts?
The 2025 drug deductible is $70.00. The plan has at least one drug tier with no deductible.
Is this a 4-star or 5-star plan?
The latest CMS score is ★3.5 out of 5 stars; anything 4 or higher earns quality bonuses.
How many members does HumanaChoice Giveback H5216-445 have?
As of last month, about 78 beneficiaries are enrolled.
Contact Humana
| Website: | Humana Plan Page |
|---|---|
| Providers: | Humana Providers Page |
| Formulary: | Humana Formulary Page |
| Pharmacy: | Humana Pharmacy Page |
| New Member Health Plan Help: | (800)833-2364 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)833-2364 |
| New Member Part D TTY Users: | 711 |
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.
- Humana, http://www.humana.com/medicare, Last Accessed June 1, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet", Last Accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You", Last Accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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