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Humana USAA Honor Giveback with Rx (PPO)

H5216 - 305 - 0
3.5 out of 5 stars (3.5 / 5)

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Humana USAA Honor Giveback with Rx (PPO) is a Medicare Advantage Plan by Humana.

This page features plan details for 2025 Humana USAA Honor Giveback with Rx (PPO) H5216 – 305 – 0 available in Michigan.

Locations

Humana USAA Honor Giveback with Rx (PPO) is offered in the following locations.

Alcona County, Michigan
Alger County, Michigan
Allegan County, Michigan

Click to see more locations

Plan Overview

Humana USAA Honor Giveback with Rx (PPO) offers the following coverage and cost-sharing.

Insurer:Humana
Health Plan Deductible:$0
MOOP:$13,300 In and Out-of-network
$8,850 In-network
Drugs Covered:Yes

Ready to sign up for Humana USAA Honor Giveback with Rx (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Humana USAA Honor Giveback with Rx (PPO) qualifies for a monthly Medicare Give Back Benefit of $66.00.

Premium Reduction:$66.00

Premium Breakdown

Humana USAA Honor Giveback with Rx (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $66.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Humana USAA Honor Giveback with Rx (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $350.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $350.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Humana USAA Honor Giveback with Rx (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Endodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Periodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Prosthodontics, fixed
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)
  • Restorative Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
    • Out-of-Network: No Coins – 0.00 Copay (Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Other Preventive Dental Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: No Coins – 0.00 Copay

Diagnostic procedures/lab services/imaging

  • Outpatient x-rays
    • Out-of-Network: $0-130 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $0-635 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-105 copay or 20% coinsurance (Authorization Required)
    • Out-of-Network: $0-105 copay or 20% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0-130 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-635 copay (Authorization Required)
  • Lab services
    • In-Network: $0-50 copay (Authorization Required)
    • Out-of-Network: $0-50 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
  • Specialist
    • In-Network: $50 copay per visit
    • Out-of-Network: $50 copay per visit
  • Primary
    • Out-of-Network: $0 copay

Emergency care/Urgent care

  • Urgent care
    • $45 copay per visit (always covered)
  • Emergency
    • $110 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: $50 copay (Authorization Required)
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • In-Network: $50 copay (Authorization Required)

Ground ambulance

    • Out-of-Network: $315 copay
    • In-Network: $315 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)
  • Hearing aids
    • In-Network: $699-999 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $50 copay (Authorization Required)
  • Hearing aids
    • Out-of-Network: $699-999 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • In-Network: $50 copay (Authorization Required)

Inpatient hospital coverage

    • In-Network: $450 per day for days 1 through 5
      $0 per day for days 6 through 90
      $0 per day for days 91 and beyond (Authorization Required)
    • Out-of-Network: $450 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $13,300 In and Out-of-network
      $8,850 In-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: $0 copay or 10-20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • Out-of-Network: $450 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $45 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $45 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $450 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient individual therapy visit
    • Out-of-Network: $45 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $45 copay (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $45 copay (Authorization Required)
    • Out-of-Network: $45 copay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $45 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $45 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: $0-450 copay per visit (Authorization Required)
    • In-Network: $0-450 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Occupational therapy visit
    • Out-of-Network: $35 copay (Authorization Required)
    • In-Network: $35 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $35 copay (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Other
    • Not covered
  • Eyeglass frames
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply, Authorization Required)
    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply, Authorization Required)
  • Upgrades
    • Not covered
  • Eyeglass lenses
    • Not covered
  • Routine eye exam
    • Out-of-Network: $0 copay (Limits Apply, Authorization Required)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered (Authorization Required)

Ready to sign up for Humana USAA Honor Giveback with Rx (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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