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Humana Essentials Plus Giveback H4461-039 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H4461-039 (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 H4461-039 (HMO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H4461-039 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Nashville. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Essentials Plus Giveback H4461-039 (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 H4461-039 (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 H4461-039 (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 $120.00. 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 a $565.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 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 H4461-039 (HMO) plan features an annual drug deductible of $565. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $3 copay for a 1-month supply at standard pharmacies or no copay for a 3-month supply through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply at standard pharmacies and mail-order services. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs costing 38% coinsurance and Tier 5 specialty drugs carrying a 26% coinsurance for a 1-month supply. This drug coverage structure offers clear cost-sharing details to help you estimate your out-of-pocket expenses.
Additional Benefits
The Humana Essentials Plus Giveback H4461-039 (HMO) plan offers robust coverage for essential medical care, featuring no copay for primary care visits, home health services, and preventive care. Specialist visits require a $40 copay, while emergency care carries a $115 copay that is waived if you are admitted. For hospital stays, members pay a daily copay of $375 for the first few days of inpatient care, with no copay and no coinsurance for subsequent days. This plan also includes valuable supplemental benefits, such as dental coverage up to a $3,000 annual limit with no copays or coinsurance for most preventive and comprehensive services. Routine vision and hearing exams are available with no copay, alongside a $200 annual allowance for eyewear and affordable copays for prescription hearing aids. Durable medical equipment is covered with a 19% coinsurance, and diagnostic services like lab tests and outpatient X-rays are provided with no copay.
Inpatient Hospital See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, subject to prior authorization. Acute stays require a $375 daily copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays have a $375 daily copay for days 1 through 4 and no copay for days 5 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while individual and group outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Humana Essentials Plus Giveback H4461-039 (HMO) plan with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are not covered under this plan.
Emergency Services See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours and does not count toward a deductible. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Essentials Plus Giveback H4461-039 (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Therapy services, including physical and occupational, require a $20 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Humana Essentials Plus Giveback H4461-039 (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select fitness and in-home support benefits. The benefit is partially covered, as services such as health education, in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers Medicare-covered hearing exams with a $40 copay and no coinsurance, while routine exams and fitting evaluations are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $799, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers select vision services with no coinsurance, including one routine eye exam per year and contact lenses or eyeglasses (lenses and frames) up to a $200 annual limit with no copay. Prior authorization is required, and other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Essentials Plus Giveback H4461-039 (HMO) up to a $3,000 annual limit, offering no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $40 copay with no coinsurance, prosthodontics require a 30% coinsurance with no copay, and fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Essentials Plus Giveback H4461-039 (HMO) with no copay and no coinsurance, although prior authorization is required. Covered Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Humana Essentials Plus Giveback H4461-039 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers durable medical equipment (DME) with a 19% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copays. Diagnostic procedures and tests carry no coinsurance and a copay ranging from $0 to $65, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $40 copay.
Home Health Services See details
Home health services are covered under the Humana Essentials Plus Giveback H4461-039 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Essentials Plus Giveback H4461-039 (HMO) with no coinsurance and require prior authorization. While some services are covered, in practice, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Humana Essentials Plus Giveback H4461-039 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 copayment for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Essentials Plus Giveback H4461-039 (HMO) partially covers other services, which include acupuncture for a $40 copay and no coinsurance (up to 20 treatments per year) and chronic illness meals with no copay and no coinsurance. Both covered benefits require prior authorization, while over-the-counter (OTC) items are not covered.
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