Plan vs plan · Kennebec County, ME · 2027 plan year
HumanaChoice Giveback H5216-138 (PPO) vs Martin's Point Generations Advantage Prime (HMO)
Medicare.gov compares Medicare Advantage plans with each other. This page also shows Original Medicare, so you can see the full trade-off: premiums, copays, the yearly limit, extra benefits, and the rules about doctors and approvals.
Pinnie Direct is a free text line. Pinnie does not sell plans.
HumanaChoice Giveback H5216-138 (PPO)
- Plan premium
- $0 a month
- Yearly limit, in network
- $7,150
- 2027 star rating
- 4 of 5
- Prior authorization needed for
- 24 services
Martin's Point Generations Advantage Prime (HMO)
- Plan premium
- $60 a month
- Yearly limit, in network
- $7,150
- 2027 star rating
- 3.5 of 5
- Prior authorization needed for
- 20 services
In Maine, you can count on Medigap Plan A later, but not other plans
You can buy any Medigap plan with no health questions in the 6 months that start when you are 65 or older and have Part B. After that, Maine makes each Medigap company sell you Plan A without health questions during one month each year. For other plans, a company can ask about your health and can say no.
One exception is the trial right. If you joined Medicare Advantage when you first got Medicare at 65, or you left a Medigap plan to try Medicare Advantage for the first time, you can switch back within 36 months. Then you can buy a Medigap plan with no health questions.
Read about Medigap rights on Medicare.govYour yearly cost, side by side
Move the controls to match your year. Totals include premiums, the Part B premium, copays, and drug costs.
Want to check your exact drugs? Medicare.gov lets you enter each drug and shows what each plan charges for it. Enter your drugs on Medicare.gov
We have no Medigap Plan G price for a 65-year-old woman in Kennebec County. Enter the monthly price from your quote, or check Medigap prices for ZIP 04330 on Medicare.gov.
Original Medicare
We have no Medigap Plan G price for a 65-year-old woman here, so we cannot show this total yet. Enter your quote above to see it. Check Medigap prices on Medicare.gov
HumanaChoice Giveback H5216-138 (PPO)
PPO from Humana
$6,790 a year
- Premiums
- $2,034
- Medical costs
- $2,935
- Drugs
- $1,821
Most you can pay in a bad year, before drugs: $9,184.
Martin's Point Generations Advantage Prime (HMO)
HMO from Martin's Point Generations Advantage
$6,313 a year
- Premiums
- $3,234
- Medical costs
- $1,237
- Drugs
- $1,842
Most you can pay in a bad year, before drugs: $10,384.
With these settings, Martin's Point Generations Advantage Prime (HMO) costs about $478 less a year than HumanaChoice Giveback H5216-138 (PPO).
These are estimates, not quotes. Check every number with Medicare (Medicare.gov or 1-800-MEDICARE) and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Drug costs use typical prices for generic and brand-name drugs. Original Medicare amounts are 2027 projections from the 2026 Medicare Trustees Report. CMS sets the final amounts in November.
Text us about this comparisonWhat you pay each time you get care
In-network costs for one visit or one stay. The Original Medicare amounts follow your Medigap choice above: Plan G.
Primary doctor visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice Giveback H5216-138 (PPO)
$0
Martin's Point Generations Advantage Prime (HMO)
$0 copay
Specialist visit
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice Giveback H5216-138 (PPO)
$45
Prior authorizationMartin's Point Generations Advantage Prime (HMO)
$45
Lab tests
Original Medicare + Medigap Plan G
$0
most Medicare-covered tests
HumanaChoice Giveback H5216-138 (PPO)
$0
Prior authorizationMartin's Point Generations Advantage Prime (HMO)
$0-$5 or 0%-20%
Prior authorization
MRI or CT scan
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice Giveback H5216-138 (PPO)
$0-$780
Prior authorizationMartin's Point Generations Advantage Prime (HMO)
20%
Prior authorization
Emergency room
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice Giveback H5216-138 (PPO)
$130
Martin's Point Generations Advantage Prime (HMO)
$130
Urgent care
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice Giveback H5216-138 (PPO)
$50
Martin's Point Generations Advantage Prime (HMO)
$50
Outpatient surgery
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice Giveback H5216-138 (PPO)
$0-$725
Prior authorizationMartin's Point Generations Advantage Prime (HMO)
$350
Prior authorization
Ground ambulance
Original Medicare + Medigap Plan G
$0
after the $292 yearly Part B deductible
HumanaChoice Giveback H5216-138 (PPO)
$325
Prior authorizationMartin's Point Generations Advantage Prime (HMO)
$325
Prior authorization
Hospital stay, 5 days
Original Medicare + Medigap Plan G
$0
Plan G pays the $1,788 Part A deductible
HumanaChoice Giveback H5216-138 (PPO)
$2,150
for a 5-day stay
Prior authorizationMartin's Point Generations Advantage Prime (HMO)
$2,450
for a 5-day stay
Prior authorization
See every cost in one table
| What you pay in network | Original Medicare + Medigap Plan G | HumanaChoice Giveback H5216-138 (PPO) | Martin's Point Generations Advantage Prime (HMO) |
|---|---|---|---|
| Monthly premium | Part B $209.50 + Medigap Plan G at the price of your quote + drug plan $5.30 | $0 (pays back $40 a month of your Part B premium) + Part B $209.50 | $60 + Part B $209.50 |
| Yearly limit on what you pay | You pay the $292 Part B deductible. Plan G pays the rest. | $7,150 in network; $10,750 in and out of network | $7,150 in network |
| Medical deductible | $292 Part B. Plan G pays the $1,788 Part A deductible. | $700 | $0 |
| Primary doctor visit | $0, after the $292 yearly Part B deductible | $0 copay | $0 copay |
| Specialist visit | $0, after the $292 yearly Part B deductible | $45 copayPrior authorization | $45 copay |
| Lab tests | $0, most Medicare-covered tests | $0 copayPrior authorization | $0-$5 copay, 0%-20% coinsurancePrior authorization |
| MRI or CT scan | $0, after the $292 yearly Part B deductible | $0-$780 copayPrior authorization | 20% coinsurancePrior authorization |
| X-rays | $0, after the $292 yearly Part B deductible | $0-$145 copayPrior authorization | 15% coinsurancePrior authorization |
| Emergency room | $0, after the $292 yearly Part B deductible | $130 copay | $130 copay |
| Urgent care | $0, after the $292 yearly Part B deductible | $50 copay | $50 copay |
| Outpatient hospital | $0, after the $292 yearly Part B deductible | $0-$800 copayPrior authorization | $0-$395 copayPrior authorization |
| Surgery center | $0, after the $292 yearly Part B deductible | $0-$725 copayPrior authorization | $350 copayPrior authorization |
| Ground ambulance | $0, after the $292 yearly Part B deductible | $325 copayPrior authorization | $325 copayPrior authorization |
| Hospital stay | $0, Plan G pays the $1,788 Part A deductible | $430 per day for days 1-6; $0 per day for days 7-90Prior authorization | $490 per day for days 1-5; $0 per day for days 6-90Prior authorization |
| Skilled nursing facility | $0, Plan G pays days 21-100 | $10 per day for days 1-20; $221 per day for days 21-100Prior authorization | $10 per day for days 1-20; $221 per day for days 21-100Prior authorization |
| Mental health visit | $0, after the $292 yearly Part B deductible | $35 copayPrior authorization | $25 copayPrior authorization |
| Physical therapy | $0, after the $292 yearly Part B deductible | $40 copayPrior authorization | $30 copay |
| Home health care | $0, Medicare-covered home health | $0 copayPrior authorization | $0 copayPrior authorization |
| Medical equipment | $0, after the $292 yearly Part B deductible | 10% coinsurancePrior authorization | 20% coinsurancePrior authorization |
| Part B drugs | $0 after the $292 Part B deductible | 0%-20% coinsurancePrior authorization | 0%-20% coinsurancePrior authorization |
| Drug deductible (Part D) | $700 with Wellcare Value Script (PDP) | $700 | $500 |
| Drug tiers (one month, retail) | Generic: $0 copayPreferred Brand: 25% coinsuranceNon-Preferred Drug: 47% coinsuranceInjectable Drugs: 15% coinsuranceSpecialty Tier: 25% coinsuranceSelect Care Drugs: $11 copay | Preferred Generic: $0 copayGeneric: $4 copayPreferred Brand: 19% coinsuranceNon-Preferred Drug: 30% coinsuranceSpecialty Tier: 25% coinsurance | Preferred Generic: $0 copayGeneric: $5 copayPreferred Brand: 22% coinsuranceNon-Preferred Drug: 29% coinsuranceSpecialty Tier: 28% coinsuranceSelect Care Drugs: $0 copay |
Not sure which of these costs apply to you?
Text us what you have now. We will help you read this comparison and check it with Medicare.gov.
A higher drug plan premium is not, by itself, a reason to switch
With Original Medicare, you buy a separate drug plan. In Maine, 8 drug plans are for sale for 2027, from $5.30 to $175.80 a month. Half of them cost $37.70 a month or less.
- Every 2027 drug plan limits what you pay for covered drugs to $2,400 a year. The drug coverage in Medicare Advantage plans has the same limit.
- The premium is one part of your yearly cost. The calculator above adds premiums, medical costs, and drug costs, so you can see the whole year.
- A Medicare Advantage plan can cost less in a light year. But you also take on its network and prior authorization rules, and you may not be able to get Medigap later.
- If your income is limited, Extra Help can pay most of your drug plan premium and drug costs. Check Extra Help at SSA.gov
Doctors, referrals, and prior authorization
Cost is one side. The other side is how you get care. These rules come from the CMS plan files. Prior authorization means the plan must approve a service before you get it.
Original Medicare
- Any doctor or hospital in the U.S. that takes Medicare
- No referrals
- Prior authorization only for a short list of services
HumanaChoice Giveback H5216-138 (PPO)
PPO
- The plan has a network. You can go outside it, but you pay more.
- No referral needed to see a specialist.
Prior authorization for 24 services
Specialist visits, Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Mental health visits, Psychiatrist visits, Physical therapy, Occupational therapy, Home health, Partial hospitalization, Cardiac rehab, Pulmonary rehab, Medical equipment, Prosthetics, Diabetic supplies, Dialysis, Substance use care, Hospital stay, Skilled nursing, Part B drugs
Martin's Point Generations Advantage Prime (HMO)
HMO
- You use doctors and hospitals in the plan network. Outside the network, the plan pays for emergencies and urgent care.
- You need a referral to see a specialist.
Prior authorization for 20 services
Diagnostic tests, MRI or CT, Radiation therapy, Outpatient hospital, Observation stay, Surgery center, Ambulance, Mental health visits, Psychiatrist visits, Home health, Partial hospitalization, Cardiac rehab, Pulmonary rehab, Medical equipment, Prosthetics, Dialysis, Substance use care, Hospital stay, Skilled nursing, Part B drugs
Extra benefits
| Extra benefit | Original Medicare | HumanaChoice Giveback H5216-138 (PPO) | Martin's Point Generations Advantage Prime (HMO) |
|---|---|---|---|
| Dental | No | Preventive only | Comprehensive, up to $500 a year |
| Eye exam | No | Yes | Yes |
| Glasses or contacts | No | Yes, $100 allowance | Yes, $150 allowance |
| Hearing aids | No | Yes, copays from $575 | Yes, up to $500 |
| Over-the-counter allowance | No | No | $100 a year |
| Fitness benefit | No | Yes | Yes |
| Rides to care | No | No | No |
| Meals after a hospital stay | No | Yes | No |
| Emergency care abroad | Plan G and Plan N pay 80% after a $250 deductible | Yes | Yes |
| Part B premium giveback | No | $40 a month | No |
What changed for 2027
HumanaChoice Giveback H5216-138 (PPO)
Renewal Plan · 2026 plan H5216-138-0
- In-network out-of-pocket maximum up from $6,500 to $7,150
- Medical deductible up from $675 to $700
- Drug deductible up from $395 to $700
- Part B giveback down from $61 to $40
- Outpatient hospital: $0-$575 copay to $0-$800 copay
- Ground ambulance: $335 copay to $325 copay
- Inpatient hospital: $445 per day for days 1-6; $0 per day for days 7-90 to $430 per day for days 1-6; $0 per day for days 7-90
- Skilled nursing facility: $10 per day for days 1-20; $218 per day for days 21-100 to $10 per day for days 1-20; $221 per day for days 21-100
- Eyewear allowance down from $200 to $100
- Rides to care removed
- Overall star rating up from 3.5 to 4
Martin's Point Generations Advantage Prime (HMO)
Renewal Plan with SAR · New for 2027
No change found in the fields we track.
More 2027 plans in Kennebec County
- AARP Medicare Advantage from UHC ME-0002 (PPO), H2001-153 (page for Cumberland County, ME)
- HumanaChoice Giveback H7617-046 (PPO) (page for Hillsborough County, NH)
- Martin's Point Generations Advantage Essential (HMO), H5591-018 (page for Cumberland County, ME)
- Humana Gold Plus H5619-137 (HMO) (page for Hillsborough County, NH)
- Martin's Point Generations Advantage Alliance (HMO), H5591-003 (page for Cumberland County, ME)
- AARP Medicare Advantage from UHC ME-0001 (HMO-POS), H5253-162 (page for Cumberland County, ME)
- Humana USAA Honor Giveback (PPO), H5216-059 (page for Hartford County, CT)
- Wellcare Low Premium Open (PPO), H2775-109 (page for Cumberland County, ME)
County guide: 2027 plans in Kennebec CountyState guide: Maine
Questions about your choice? Text us.
Pinnie Direct is a free text line. Tell us what you have now and we will help you read this comparison.
Sources and method
Plan data comes from the CMS 2027 Plan Benefit Package and landscape files. The data is from 2026-10-10. We checked a sample of plans field by field against Medicare.gov. Original Medicare amounts are the 2027 projections in the 2026 Medicare Trustees Report (Tables V.E1 and V.E2). CMS sets the final amounts in November. We do not have a Medigap price for Kennebec County, ME. So the Original Medicare total needs your own Medigap quote. You can look up prices for ZIP 04330 on Medicare.gov. Totals use typical Medicare-allowed amounts for each service and typical drug prices.
- HumanaChoice Giveback H5216-138 (PPO) on Medicare.gov · plan website · drug list · doctor directory
- Martin's Point Generations Advantage Prime (HMO) on Medicare.gov · plan website · drug list · doctor directory
- Medigap prices for ZIP 04330 on Medicare.gov
- CMS Plan Benefit Package files, 2027
- CMS 2027 landscape files (premiums and limits)
- CMS 2027 plan crosswalk
- CMS 2027 Star Ratings
- 2026 Medicare Trustees Report: projected 2027 Part A and Part B amounts (Tables V.E1 and V.E2)
- CMS 2026 Part A and Part B amounts
- Medicare.gov: Medigap guaranteed issue rights
These are estimates, not quotes, and they are for education only. Check every number with Medicare and with the plan before you choose. What you pay depends on your doctors and hospitals, your drugs and pharmacy, and the care you use. Plans can change their benefits, premiums, drug lists, and networks each year.
Pinnie is not an insurance agent or broker and does not sell Medicare plans. Pinnie is not connected with or endorsed by the U.S. government or the federal Medicare program. For all your options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.