A non-government entity
Humana Essentials Plus Giveback H5216-308 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H5216-308 (PPO). 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 H5216-308 (PPO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H5216-308 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Virginia and Delaware. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Essentials Plus Giveback H5216-308 (PPO) 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 H5216-308 (PPO).
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 H5216-308 (PPO), 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 $117.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $350.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $390.00 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 combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 H5216-308 (PPO)
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 H5216-308 (PPO) plan features an annual drug deductible of $390. For Tier 1 preferred generic drugs, members pay no copay at standard pharmacies and through preferred mail order, while standard mail order costs between $10 and $30. Tier 2 generic drugs require a low $1 copay for a one-month supply at standard pharmacies and preferred mail order, with no copay for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs carry a $30 copay for a one-month supply at standard pharmacies or preferred mail order, while standard mail order costs $47. For higher-tier medications, Tier 4 non-preferred drugs incur a 34% coinsurance across all pharmacy options, and Tier 5 specialty drugs require a 28% coinsurance for a one-month supply.
Additional Benefits
The Humana Essentials Plus Giveback H5216-308 (PPO) plan offers robust coverage for essential medical services, featuring no copays and no coinsurance for primary care visits, preventive care, and home health services. For specialist visits and outpatient therapy, members pay a predictable $35 copay with no coinsurance. Inpatient hospital stays require a daily copay of $345 for the first five to seven days before transitioning to no copay, while emergency room visits carry a $115 copay that is waived if admitted. This plan also includes valuable dental, vision, and hearing benefits, providing routine exams, contact lenses, and preventive dental care with no copay or coinsurance. Vision benefits feature a $75 annual exam allowance alongside a $150 eyewear allowance, while prescription hearing aids require copays ranging from $699 to $999. For recovery and medical equipment, skilled nursing facility stays have no copay for the first 20 days, and durable medical equipment is covered with no copay and a 17% coinsurance.
Inpatient Hospital See details
Humana Essentials Plus Giveback H5216-308 (PPO) inpatient hospital services are partially covered with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $345 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $345 daily copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Humana Essentials Plus Giveback H5216-308 (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $450 copay and observation services with a $345 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Essentials Plus Giveback H5216-308 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H5216-308 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, with prior authorization required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Humana Essentials Plus Giveback H5216-308 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. 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 H5216-308 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Physical and occupational therapy are covered with a $25 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Humana Essentials Plus Giveback H5216-308 (PPO) plan, featuring no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, glaucoma screenings, and memory fitness. However, sub-services including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Essentials Plus Giveback H5216-308 (PPO), featuring routine hearing exams and fitting evaluations with no copay and no coinsurance, alongside Medicare-covered exams for a $35 copay and no coinsurance. Prescription hearing aids are covered for a copay of $699 to $999 and no coinsurance, 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 H5216-308 (PPO) partially covers vision services with no coinsurance and copays ranging from $0 to $35, including a $75 annual allowance for exams and a $150 annual allowance for eyewear. Routine eye exams, contact lenses, and eyeglasses have no copay, but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Essentials Plus Giveback H5216-308 (PPO) offers partially covered dental services with a $35 copay and no coinsurance for Medicare dental services, and no copay or coinsurance for other covered preventive and comprehensive dental care. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Essentials Plus Giveback H5216-308 (PPO) with no copay, while associated Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance. Covered Part B insulin has a $35 copay and 0% to 20% coinsurance, with prior authorization and step therapy requirements applying to these services.
Dialysis Services See details
Dialysis services are covered under the Humana Essentials Plus Giveback H5216-308 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical equipment is covered by Humana Essentials Plus Giveback H5216-308 (PPO) with no copay and 17% coinsurance for durable medical equipment. Prosthetics and medical supplies require no copay and 20% coinsurance, while diabetic supplies have no copay and 10% to 20% coinsurance, and diabetic therapeutic shoes require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Humana Essentials Plus Giveback H5216-308 (PPO) plan, requiring prior authorization. Diagnostic tests and procedures feature no coinsurance and copays from $0 to $120, lab services and outpatient X-rays carry no copay, and therapeutic radiological services require a minimum 20% coinsurance and a $35 copay.
Home Health Services See details
Home Health Services are covered under the Humana Essentials Plus Giveback H5216-308 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Humana Essentials Plus Giveback H5216-308 (PPO) plan require prior authorization and feature no coinsurance. While some services are covered, specific sub-services such as cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and SET for PAD services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Essentials Plus Giveback H5216-308 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Humana Essentials Plus Giveback H5216-308 (PPO) partially covers other services, including acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year, and meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
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