Humana USAA Honor (PPO)
H5216 - 234 - 0
(4.5 / 5)
Humana USAA Honor (PPO) is a Medicare Advantage Plan by Humana.
This page features plan details for 2024 Humana USAA Honor (PPO) H5216 – 234 – 0 available in Honolulu, Kauai, and Maui counties.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
Locations
Humana USAA Honor (PPO) is offered in the following locations.
Plan Overview
Humana USAA Honor (PPO) offers the following coverage and cost-sharing.
| Insurer: | Humana |
| Health Plan Deductible: | $1,000 annual deductible |
| MOOP: | $11,300 In and Out-of-network $7,550 In-network |
| Drugs Covered: | No |
Please Note:
- This plan's deductible only applies to out-of-network services.
Ready to sign up for Humana USAA Honor (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 (PPO) qualifies for a monthly Medicare Give Back Benefit of $50.00.
| Premium Reduction: | $50.00 |
Premium Breakdown
Humana USAA Honor (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $50.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Humana USAA Honor (PPO) also provides the following benefits.
| $1,000 annual deductible |
| In-network | No |
| $11,300 In and Out-of-network $7,550 In-network |
| Yes |
| In-network | No |
| In-network | $0-350 copay or 20% coinsurance per visit (Authorization is required.) (Referral is not required.) |
| out-of-network | 40% coinsurance per visit (Authorization is required.) (Referral is not required.) |
| In-network Primary | $0 copay (Not applicable.) (Not applicable.) |
| out-of-network Primary | $40 copay per visit (Not applicable.) (Not applicable.) |
| In-network Specialist | $45 copay per visit (Authorization is not required.) (Referral is not required.) |
| out-of-network Specialist | $65 copay per visit (Authorization is not required.) (Referral is not required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network | $0 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $20 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | $0-45 copay or 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic tests and procedures | $40-65 copay or 20-40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Lab services | $40 copay or 20-40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Diagnostic radiology services (e.g., MRI) | $0-175 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | $40 copay or 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient x-rays | $0 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient x-rays | $40 copay or 20-40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Hearing exam | $45 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Hearing exam | $65 copay (Authorization is required.) (Referral is not required.) |
| In-network Fitting/evaluation | $0 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
| out-of-network Fitting/evaluation | 50% coinsurance (There are no limits.) (Authorization is required.) (Referral is not required.) |
| In-network Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing aids | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Diagnostic services | 0% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic services | $25 copay or 0% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Restorative services | $25 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Restorative services | $25 copay or 0% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Periodontics | $25 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Periodontics | $25 copay or 0% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Contact lenses | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| In-network Occupational therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Occupational therapy visit | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
| out-of-network Physical therapy and speech and language therapy visit | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network | 20% coinsurance (Not applicable.) (Not applicable.) |
| out-of-network | 20% coinsurance (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| In-network Foot exams and treatment | $45 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Foot exams and treatment | $65 copay (Authorization is required.) (Referral is not required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 13% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 25% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Prosthetics (e.g., braces, artificial limbs) | 30% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay or 10-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Diabetes supplies | 40% coinsurance per item (Authorization is required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| In-network Chemotherapy | 0-19% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Chemotherapy | 40% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | 0-19% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Other Part B drugs | 40% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | 0-19% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
| out-of-network Part B Insulin drugs | 40% coinsurance (Authorization is required.) (Not applicable.) |
| In-network | $390 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 90 and beyond (Authorization is required.) (Referral is not required.) |
| out-of-network | 40% per stay (Authorization is required.) (Referral is not required.) |
| In-network Inpatient hospital – psychiatric | $390 per day for days 1 through 4 $0 per day for days 5 through 90 (Authorization is required.) (Referral is not required.) |
| out-of-network Inpatient hospital – psychiatric | 40% per stay (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit with a psychiatrist | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit with a psychiatrist | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network | $0 per day for days 1 through 20 $178 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
| out-of-network | 40% per stay (Authorization is required.) (Referral is not required.) |
| Monthly Premium | $32.00 |
| Deductible | nan |
| Monthly Premium | $48.60 |
| Deductible | nan |
| Monthly Premium | $59.80 |
| Deductible | nan |
Ready to sign up for Humana USAA Honor (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
Table of Contents
Need more information on Humana USAA Honor (PPO)? See 2025 Humana USAA Honor (PPO) at MedicareAdvantageRX.com.
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