A non-government entity
Humana Essentials Plus Giveback H4461-045 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H4461-045 (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 H4461-045 (HMO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H4461-045 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Missouri. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Essentials Plus Giveback H4461-045 (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 H4461-045 (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 H4461-045 (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 $71.00. 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 $615.00 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 $4200.00 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:
Sign up for Humana Essentials Plus Giveback H4461-045 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Essentials Plus Giveback H4461-045 (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members enjoy no copay at standard pharmacies and through preferred mail order for both one-month and three-month supplies. Tier 2 generic medications require a $5 copay for a one-month supply, or no copay for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs cost a $47 copay for a one-month supply, with three-month supplies ranging from $131 to $141 depending on the pharmacy service. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 48% coinsurance, while Tier 5 specialty drugs incur a 25% coinsurance for a one-month supply.
Additional Benefits
The Humana Essentials Plus Giveback H4461-045 (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits and routine preventive services. For inpatient hospital stays, you will pay a daily copay for the first seven days before transitioning to no copay for subsequent days. Outpatient hospital services feature no coinsurance and copays ranging from no copay up to $300, while specialist visits require a $30 copay. This plan also provides robust supplemental benefits, including dental coverage up to $3,500 annually with no copay or coinsurance for most preventive and comprehensive services. Vision and hearing benefits feature no copay for routine exams, alongside a $150 annual allowance for eyewear and covered over-the-counter hearing aids. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Essentials Plus Giveback H4461-045 (HMO) with no coinsurance and required prior authorization. Acute care requires a $375 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $334 daily copay for days 1-7 and no copay for days 8-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Essentials Plus Giveback H4461-045 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $30 to $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Essentials Plus Giveback H4461-045 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H4461-045 (HMO) partially covers ambulance and transportation services, requiring prior authorization for ambulance transport. Covered ground ambulance services require a $335 copay and no coinsurance, air ambulance services require a 20% coinsurance and no copay, and transportation services to health-related locations are not covered.
Emergency Services See details
Humana Essentials Plus Giveback H4461-045 (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 $65 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 H4461-045 (HMO) primary care benefits are partially covered, as chiropractic and podiatry services are not covered. Covered primary care visits require no copay and no coinsurance, while specialist, mental health, and therapy services have a $30 copay and no coinsurance. Additional telehealth services are also available with a copay ranging from no copay to $65 and no coinsurance.
Preventive Services See details
Humana Essentials Plus Giveback H4461-045 (HMO) covers preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, and memory fitness. However, this benefit is only partially covered, as supplemental services like health education, in-home safety assessments, personal emergency response systems, and weight management are not covered.
Hearing Services See details
Humana Essentials Plus Giveback H4461-045 (HMO) covers hearing exams with a $30 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Humana Essentials Plus Giveback H4461-045 (HMO) with no coinsurance, no deductibles, and no copays for covered benefits, though prior authorization is required. Covered benefits include one routine eye exam per year and up to $150 annually for contact lenses or eyeglasses (lenses and frames), whereas other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Essentials Plus Giveback H4461-045 (HMO) partially covers dental services up to $3,500 annually, featuring no copay and no coinsurance for most preventive and comprehensive care, alongside a 30% coinsurance and no copay for prosthodontics. Medicare-covered dental services require a $30 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Essentials Plus Giveback H4461-045 (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and coinsurance ranging from no coinsurance to 20%, while covered Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Essentials Plus Giveback H4461-045 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Essentials Plus Giveback H4461-045 (HMO) covers durable medical equipment and prosthetic devices with a 20% coinsurance and no copay, and medical supplies with a 15% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Essentials Plus Giveback H4461-045 (HMO) with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures range from a $0 to $65 copay and therapeutic radiological services require a minimum copay of $30.
Home Health Services See details
Humana Essentials Plus Giveback H4461-045 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Essentials Plus Giveback H4461-045 (HMO) with no copay and no coinsurance, but prior authorization is required. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Essentials Plus Giveback H4461-045 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not needed, and additional days beyond Medicare-covered days are not covered.
Other Services See details
Other Services under the Humana Essentials Plus Giveback H4461-045 (HMO) plan include acupuncture for a $30 copay and no coinsurance, which is limited to 20 treatments per year and requires prior authorization. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, though the meal benefit requires prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved