Humana USAA Honor Giveback (PPO)

HUMANA INSURANCE COMPANY · 2026 plan year

Plan ID H5216-386-001

Showing MD · also offered in: DC

Local PPO★ 3.5 CMS Stars
MOOP (in-network)
$6,750
MOOP (combined)
$10,100
Monthly premium
$0/mo
Prescription drugs
Not included

Plan information

Contract / Plan / Segment
H5216-386-001
Medical deductible
$0 — no deductible
Also owed
Your Medicare Part B premium, paid separately

Other segments for this plan:

More HUMANA INSURANCE COMPANY plans in MD

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$380/day for days 1–5, $0 after
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$375/day for days 1–4, $0 after
Worldwide Urgent Care Coverage$130

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual SessionsNo charge
Mental Health — Group SessionsNo charge
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Laboratory Services$0-$50
Skilled Nursing Facility (SNF)$10/day for days 1–20, $218/day for days 21–100
Cardiac Rehabilitation — Additional Sessions$10-$40
Intensive Cardiac Rehabilitation — Additional Sessions$10-$40
Pulmonary Rehabilitation — Additional Sessions$10
Supervised Exercise Therapy (SET)$10
Emergency Services$130
Urgently Needed Services$50
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency Coverage$130
Worldwide Emergency Transportation$130
Partial Hospitalization Program$35
Intensive Outpatient Program (IOP)$35
Radiological ServicesSee plan details
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic Services$15
Occupational Therapy Services$10-$40
Physician Specialist Services$40
Podiatry Services$40
Other Health Care Professional Services$0-$40
Psychiatric Services — Individual SessionsNo charge
Psychiatric Services — Group SessionsNo charge
Physical Therapy & Speech-Language Pathology$10-$40
Additional Telehealth Services (Part B)$0-$50
Opioid Treatment Program ServicesNo charge
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests$0-$100
Diagnostic Radiology$0-$780
Therapeutic Radiology$40 copay + 20% coinsurance
X-Ray Services$0-$100
Outpatient Hospital Services$0-$700
Hospital Observation Services$380 per stay
Ambulatory Surgical Center (ASC)$0-$600
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual SessionsNo charge
Substance Abuse — Group SessionsNo charge
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$335
Air Ambulance$335
Non-Emergency Transportation — Health FacilityNo charge
Durable Medical Equipment (DME)20% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices20% coinsurance
Medical Supplies20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic Supplies10%-20% coinsurance
Diabetic Therapeutic Shoes & Inserts$10
Dialysis Services20% coinsurance
Acupuncture$40
Over-the-Counter (OTC) ItemsNo charge
Diabetes Self-Management TrainingNo charge
Meal BenefitNo charge
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Fitness BenefitNo charge
Wigs for Chemotherapy Hair LossNo charge
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)0%-20% coinsurance (max $35)
Dental — Medicare-Covered Services$40
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Diagnostic ServicesNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Other Preventive ServicesNo charge
Dental — ComprehensiveSee plan details
Dental — Restorative ServicesNo charge
Dental — Endodontics (Root Canal)No charge
Dental — Periodontics (Gum Care)No charge
Dental — Removable Prosthodontics (Dentures)No charge
Dental — Fixed Prosthodontics (Bridges)No charge
Dental — Oral & Maxillofacial SurgeryNo charge
Dental — Adjunctive General ServicesNo charge
Vision — Eye Exams$0-$40
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Hearing — Exams$40
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)$699-$999
Cardiac & Pulmonary RehabilitationSee plan details
Psychiatric ServicesSee plan details
Hearing — OTC Hearing AidsNo charge

Service area

  • MD: 19 counties

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