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HumanaChoice Giveback H5216-404 (PPO) Medicare Advantage Plan H5216-404 • 2027 • Stone County, MO

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$700
Maximum Out-of-Pocket
$5500.00In-network
Part B Giveback
−$61.00 reduction
Prescription Coverage
Enhanced, $700.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
Stone County, MO
Local Enrollment
84 beneficiaries in Stone County
Last update:

HumanaChoice Giveback H5216-404 (PPO) Introduction

This Medicare Advantage PPO plan, HumanaChoice Giveback H5216-404, is offered by Humana and uses a Preferred Provider Organization (PPO) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $700, and the in-network maximum out-of-pocket is $5500.00. The plan is identified by CMS Plan ID H5216-404. The 2027 Part D prescription drug deductible is $700.00.

Enrollment in this plan requires residence in Stone County, Missouri. CMS enrollment data reports 84 plan members in Stone County. New members can call the plan directly at (888)873-0686 (TTY 711) for assistance.

Compare Similar Plans in Stone County

Compare this plan with the two most-enrolled PPO plans available in Stone County, Missouri. Enrollment is based on CMS local enrollment data.

PPO plan comparison for Stone County, Missouri
Plan Detail HumanaChoice Giveback H5216-404 AARP Medicare Advantage from UHC MO-0009 Humana Value Choice
CMS Plan ID H5216-404-0 H8768-027-0 H5216-318-1
Local Enrollment 84 534 439
Monthly Premium $0.00 $0.00 $0.00
Medical Deductible $700 $1,000 $650
Maximum Out-of-Pocket $5,500.00 $7,150.00 $4,450.00
Part B Giveback −$61.00 reduction Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist $45 copay $0-$70 copay $30 copay
Part D Deductible $700.00 $685.00 $700.00
CMS Star Rating Not yet rated Not yet rated Not yet rated
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $0 copay $0 copay $0 copay

Plan Benefits

HumanaChoice Giveback H5216-404 includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H5216-404.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5216-404-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Out-of-network: 40% coinsurance
Specialist
In-network: $45 copay
Out-of-network: 50% coinsurance

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Out-of-network: $0 copay
Telehealth benefit
In-network: $0-$50 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
Not covered
Counseling services
Not covered
Over-the-counter drug benefits
Not covered
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0-$345 copay
Out-of-network: $0 copay, 50% coinsurance
Lab services
In-network: $0 copay
Out-of-network: $50 copay, 50% coinsurance
Outpatient x-rays
In-network: $0-$145 copay
Out-of-network: $50 copay, 40%-50% coinsurance
Diagnostic tests and procedures
In-network: $0-$90 copay
Out-of-network: $50 copay, 40%-50% coinsurance

Emergency and Urgent Care Services

Emergency room care
$130 copay
Worldwide emergency care
Coming soon
Urgent care
$50 copay
Inpatient hospital care
In-network:
Tier 1
$425 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
50% per stay
Skilled Nursing Facility
In-network:
Tier 1
$10 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
50% per stay
Ground ambulance
In-network: $325 copay
Out-of-network: $325 copay

Mental Health Services

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
$425 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
50% per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $40 copay
Out-of-network: 40% coinsurance
Occupational therapy
In-network: $40 copay
Out-of-network: 40% coinsurance

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay, 10%-20% coinsurance
Out-of-network: 10%-50% coinsurance
Durable medical equipment
In-network: 17% coinsurance
Out-of-network: 50% coinsurance
Prosthetics
In-network: 17% coinsurance
Out-of-network: 50% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance

Dental Services

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%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Endodontics
In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Restorative services
In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance

Vision Services

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

Hearing Services

Hearing exam
In-network: $0 copay
Out-of-network: 95% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: 95% coinsurance
Prescription hearing aids
In-network: $575-$750 copay
Out-of-network: 95% coinsurance
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by HumanaChoice Giveback H5216-404 as a Part B benefit.

Prescription Drug Coverage

HumanaChoice Giveback H5216-404 includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

HumanaChoice Giveback H5216-404 (H5216-404-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($24.80)
Supplemental Part D Premium:$$24.80
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$18.38
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 $700.00 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 H5216-404 may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

HumanaChoice Giveback H5216-404 (H5216-404-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayComing soon
Generic$0.00 copayComing soon
Preferred Brand17% coinsuranceComing soon
Non-Preferred Drug50% coinsuranceComing soon
Specialty Tier25% coinsuranceComing soon
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H5216)

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.

2027 Medicare Star Ratings for Contract H5216
CMS Measure Star Rating
2027 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 ☆☆☆☆☆
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Humana (official source) http://www.humana.com/medicare October 4, 2026
Medicare.gov Compare types of Medicare Advantage Plans 25 May, 2025
Medicare.gov Joining a plan 25 May, 2025
Medicare.gov Explore your Medicare coverage options 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.