Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO
HumanaChoice Giveback H5216-138 (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Maine and offered by the health insurance company Humana. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Monthly Premium
$0
Annual Deductible
$540 annual deductible
Max Out-of-Pocket
$5,200
Primary doctor visit
$0 copay
Specialist visit
$50 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$315 copay
HumanaChoice Giveback H5216-138 (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $540 annual deductible and a maximum out of pocket cost sharing of $7,750 In and Out-of-network
$5,200 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for HumanaChoice Giveback H5216-138 (PPO) are defined below.
Additional Benefits and Coverage
Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing
HumanaChoice Giveback H5216-138 (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. HumanaChoice Giveback H5216-138 (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. HumanaChoice Giveback H5216-138 (PPO) includes coverage for the following additional benefits:
Other benefits
Fitness benefit
Limited coverage
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage
Comparing the Quality Score of HumanaChoice Giveback (PPO) to Other Plans in Maine
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, HumanaChoice Giveback (PPO) received an overall government quality rating of 3.5 stars out of 5 stars.
HumanaChoice Giveback (PPO) performed the same as Maine’s State average overall quality score of 3.5 stars.
This Plan’s 5-star Gov’t Quality Score
Maine State Average Score
Overall Government 5 Star Quality Rating
3.5
3.5
Summary rating of health plan quality
3.5
3.5
Staying healthy: screenings, tests, & vaccines
4
3.8
Managing chronic (long term) conditions
4
3.3
Member experience with health plan
4
3.4
Member complaints & changes in the health plan's performance
4
4.1
Health plan customer service
4
3.7
Summary rating of drug plan quality
3.5
3.6
Drug plan customer service
4
4.2
Member complaints & changes in the drug plan's performance
3
3.8
Member experience with the drug plan
4
3.5
Drug safety & accuracy of drug pricing
3
3.4
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
HumanaChoice Giveback (PPO) received 3.5 stars for its health plan quality score which is the same as the Maine State average health plan quality score of 3.5 stars.
HumanaChoice Giveback (PPO) received 3.5 stars for its drug plan quality score which is worse than the Maine State average drug plan quality score of 3.6 stars.
In-network: $0 copay
Out-of-network: $45 copay per visit
Specialist visit
In-network: $50 copay per visit
Out-of-network: $65 copay per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0-100 copay
Out-of-network: $45-65 copay or 40% coinsurance
Lab services
In-network: $0-55 copay
Out-of-network: $45-65 copay or 40% coinsurance
Diagnostic radiology services (like MRI)
In-network: $50-400 copay
Out-of-network: $65 copay or 40% coinsurance
Outpatient x-rays
In-network: $0-130 copay
Out-of-network: $45-65 copay or 40% coinsurance
Emergency care
$125 copay per visit (always covered)
Urgent care
$55 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $445 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 91 and beyond
Out-of-network: $445 per day for days 1 through 7
$0 per day for days 8 through 90
Outpatient hospital coverage
In-network: $50-550 copay per visit
Out-of-network: 40% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $10 per day for days 1 through 20
$214 per day for days 21 through 100
Out-of-network: 40% per stay
In this article we rank Maine Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
The Medicare landscape in Maine is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in Maine.
Health Plan Radar