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Humana Essentials Plus Giveback H1036-271 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H1036-271 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Essentials Plus Giveback H1036-271 (HMO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H1036-271 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Emerald Coast. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Essentials Plus Giveback H1036-271 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Essentials Plus Giveback H1036-271 (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Essentials Plus Giveback H1036-271 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $112.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Essentials Plus Giveback H1036-271 (HMO) prescription drug plan features a $0 drug deductible, allowing your coverage to begin immediately. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay for a 1-month or 3-month supply when using standard pharmacies or preferred mail order. If you use standard mail order, Tier 1 drugs have a $10 copay and Tier 2 drugs have a $20 copay for a 1-month supply. Tier 3 preferred brand drugs cost a $30 copay for a 1-month supply at standard pharmacies and through preferred mail order, or $47 through standard mail order. Tier 4 non-preferred drugs require a 35% coinsurance across all pharmacy and mail order options. Tier 5 specialty drugs carry a 33% coinsurance for a 1-month supply at standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The Humana Essentials Plus Giveback H1036-271 (HMO) plan offers robust coverage for essential medical needs, featuring no copays and no coinsurance for primary care visits, preventive services, and home health care. For specialized medical care, members pay a $35 copay for specialist visits, physical therapy, and Medicare-covered dental exams. Inpatient hospital stays require a $385 daily copay for the first seven days, while emergency room visits incur a $130 copay that is waived if the patient is admitted within 24 hours. This plan also includes supplemental vision, hearing, and dental benefits, highlighted by a $200 annual eyewear allowance and a $1,500 annual dental maximum with no copays for routine cleanings. Routine hearing and vision exams also feature no copays, though prescription hearing aids require copays ranging from $199 to $1,299. Durable medical equipment is covered with no copay and a 15% coinsurance, while skilled nursing facility stays have no copay for the first 20 days.
Inpatient Hospital See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $385 copay for days 1 through 7 and no copay for days 8 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is also covered with no coinsurance and a $275 copay for days 1 through 7 (no copay for days 8 through 90), but additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Humana Essentials Plus Giveback H1036-271 (HMO) are covered with no coinsurance, featuring a $0 to $295 copay for outpatient hospital services and a $385 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay, while individual or group outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers ground ambulance services with a copay ranging from no copay to $240 along with coinsurance, and air ambulance services with a 20% coinsurance and a copay, with prior authorization required for all ambulance services. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers primary care physician services with no copay and no coinsurance, and telehealth services with no copay to a $35 copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and speech therapy require a $35 copay and no coinsurance, while mental health sessions cost a $30 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Essentials Plus Giveback H1036-271 (HMO) with no copay and no coinsurance for covered care, such as annual physical exams, glaucoma screenings, and kidney disease education. However, several supplemental services are not covered under this plan, including health education, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers hearing services, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199 to $1,299 for up to two devices per year, while OTC hearing aids and specific prescription types like inner, outer, and over-the-ear models are not covered.
Vision Services See details
Humana Essentials Plus Giveback H1036-271 (HMO) provides partially covered vision services with no coinsurance and no copay for routine eye exams and covered eyewear, which features a $200 annual allowance for contact lenses or eyeglasses (lenses and frames). Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Essentials Plus Giveback H1036-271 (HMO) partially covers dental services up to a $1,500 annual maximum, with Medicare-covered dental requiring a $35 copay and no coinsurance. Other covered services, including cleanings, exams, and restorations, feature no copay and coinsurance ranging from 0% to 40%, though fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, requiring prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while covered Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and referrals are required to access this covered benefit.
Medical Equipment See details
Medical equipment is covered by Humana Essentials Plus Giveback H1036-271 (HMO), featuring a 15% coinsurance and no copay for durable medical equipment (DME). Prosthetics, medical supplies, and diabetic equipment are also covered with a 20% coinsurance and no copay, though prior authorization is required and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers diagnostic and radiological services, requiring referrals and prior authorization for these benefits. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $370 copay for procedures, while radiological services range from no copay for X-rays to a minimum $35 copay and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Humana Essentials Plus Giveback H1036-271 (HMO) with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Essentials Plus Giveback H1036-271 (HMO) plan because all sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered in practice despite a listed 0% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Essentials Plus Giveback H1036-271 (HMO) covers skilled nursing facility (SNF) care with no coinsurance, offering no copay for days 1 through 20 and a $160 daily copay for days 21 through 100. Prior authorization is required, but a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
Other services are partially covered by Humana Essentials Plus Giveback H1036-271 (HMO), featuring acupuncture up to 25 treatments per year and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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