2027 Medicare Advantage plan
Humana USAA Honor Giveback (PPO): 2027 benefits and costs
Humana PPO
CMS plan ID: H5216-427-3 · Plan year: 2027
Humana USAA Honor Giveback (PPO) is a 2027 Medicare Advantage plan offered by Humana. It is listed in Utah.
2027 plan costs at a glance
- Organization
- Humana
- Plan organization
- HUMANA INSURANCE COMPANY
- Parent company
- Humana Inc.
- Plan type
- PPO
- Part C premium
- $0.00
- Prescription drug coverage
- No
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
- Monthly Part B premium after plan reduction
- $109.50 (estimated)$209.50 standard premium less $100.00 plan reduction.
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- None
- In-network medical maximum
- $9,150.00
Applies to certain in-network supplemental services.
- Combined in/out-of-network medical maximum
- $13,900.00
Applies to certain in-network supplemental services.
- Out-of-network medical maximum
- Not applicable
- Part B premium reduction
- $100.00
2027 benefit summary
Doctor visits and medical care
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0.00 copay
| 30% coinsurance
| |
| Specialist visit | $50.00 copay
| 30% coinsurance
|
|
| Telehealth | $0.00 to $50.00 copay
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $115.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $40.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0.00 copay
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Kidney disease education services | $0.00 copay
| $0.00 copay
|
|
| Medicare-covered chiropractic | $15.00 copay
| 35% coinsurance
|
|
| Medicare-covered foot care | $50.00 copay
| 30% coinsurance
|
|
| Other health professionals | $0.00 to $50.00 copay
| 30% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–4: $395.00 copay per day Days 5–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–4: $395.00 copay per day Days 5–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $450.00 copay
| $0.00 copay; 30% to 50% coinsurance
| |
| Hospital observation services | $395.00 copay
| 50% coinsurance
| |
| Ambulatory surgical center | $0.00 to $350.00 copay
| $0.00 copay; 50% coinsurance
|
|
| Outpatient blood | $0.00 copay
| $0.00 copay
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $100.00 copay
| $40.00 copay; 30% to 50% coinsurance
|
|
| Laboratory services | $0.00 copay
| $40.00 copay; 50% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $345.00 copay
| $0.00 copay; 50% coinsurance
|
|
| Therapeutic radiology | $50.00 copay; 20% coinsurance
| 30% to 50% coinsurance
|
|
| X-rays | $0.00 to $145.00 copay
| $40.00 copay; 30% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $0.00 copay
| 50% coinsurance
|
|
| Intensive outpatient program | $0.00 copay
| 50% coinsurance
|
|
| Substance use treatment, individual sessions | $0.00 copay
| 35% coinsurance
|
|
| Substance use treatment, group sessions | $0.00 copay
| 35% coinsurance
|
|
| Opioid treatment program | $0.00 copay
| 35% coinsurance
|
|
| Mental health, individual sessions | $0.00 copay
| 35% coinsurance
|
|
| Mental health, group sessions | $0.00 copay
| 35% coinsurance
|
|
| Psychiatry, individual sessions | $0.00 copay
| 35% coinsurance
|
|
| Psychiatry, group sessions | $0.00 copay
| 35% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $35.00 copay
| 30% coinsurance
|
|
| Physical and speech therapy | $35.00 copay
| 30% coinsurance
|
|
| Cardiac rehabilitation | $10.00 copay
| 50% coinsurance
|
|
| Intensive cardiac rehabilitation | $10.00 copay
| 50% coinsurance
|
|
| Pulmonary rehabilitation | $10.00 copay
| 50% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $10.00 copay
| 50% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $325.00 copay
| $325.00 copay
|
|
| Air ambulance | 20% coinsurance
| 20% coinsurance
|
|
| Durable medical equipment | 18% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | $0.00 copay; 10% to 20% coinsurance
| 50% coinsurance
|
|
| Diabetic shoes and inserts | $10.00 copay
| 50% coinsurance
|
|
| Diabetic monitors | $0.00 copay; 10% to 20% coinsurance
| 50% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $50.00 copay | 30% coinsurance
| |
| Oral examsAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | $0.00 copay
| |
| Restorative dental careAdditional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | 30% coinsurance | 30% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Oral surgeryAdditional plan benefit | 0% to 30% coinsurance | 0% to 30% coinsurance
| |
| Other dental servicesAdditional plan benefit | 30% coinsurance | 30% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0.00 to $50.00 copay
| $0.00 copay; 30% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Medicare-covered eyewear | $0.00 copay
| 50% coinsurance
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $50.00 copay
| 30% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay | 95% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0.00 copay | 95% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $575.00 to $750.00 copay
| 95% coinsurance
|
|
| Over-the-counter hearing aidsAdditional plan benefit | $0.00 copay
| 95% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Supplemental acupunctureAdditional plan benefit | $50.00 copay
| $50.00 copay
|
|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| 95% coinsurance
| |
| Limited-duration mealsAdditional plan benefit | $0.00 copay
| 95% coinsurance
|
|
| Annual physical examAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
| Fitness benefitAdditional plan benefit | $0.00 copay
| 95% coinsurance
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | $0.00 copay
| |
| Glaucoma ScreeningMedicare-covered care | Out-of-network | $0.00 copay
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | $0.00 copay
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | $0.00 copay
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | $0.00 copay
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | 50% coinsurance
|
Allowances and optional benefits
OTC Max Allowance
One shared limit covers the listed services, not a separate allowance for each service.
- Services sharing this allowance
- Over-the-counter health items; Over-the-counter hearing aids
- How benefits are provided
- Debit Card
- Advance choice of benefits required
- No
- Shared benefit limit
- $50.00
- How often this limit applies
- Every three months
- Shared limit on visits or trips
- No
Benefits for qualifying members
Virtual Cardiac Recovery Program
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Congestive Heart Failure (CHF); Hypertension; Other 1; Other 2
- Qualifying conditions
- Pneumonia
- Qualifying conditions
- Respiratory Illnesses
- All listed conditions required
- No
- Combination of conditions required
- No
- Included services
- Other 1
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- No
Nutritional Benefit
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Congestive Heart Failure (CHF)
- Included services
- Meal Benefit; Nutritional/Dietary Benefit
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- No
Prescription drug coverage
This plan does not include a Part D prescription drug benefit.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.
View all locations 23 county listings across 1 state or territory
Utah
- Beaver, Utah
- Box Elder, Utah
- Cache, Utah
- Davis, Utah
- Duchesne, Utah
- Emery, Utah
- Garfield, Utah
- Grand, Utah
- Iron, Utah
- Juab, Utah
- Kane, Utah
- Millard, Utah
- Morgan, Utah
- Piute, Utah
- Rich, Utah
- Salt Lake, Utah
- San Juan, Utah
- Summit, Utah
- Tooele, Utah
- Utah, Utah
- Wasatch, Utah
- Washington, Utah
- Weber, Utah