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Humana Essentials Plus Giveback H5216-358 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H5216-358 (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 H5216-358 (PPO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H5216-358 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Texas. 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 H5216-358 (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 H5216-358 (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 H5216-358 (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 $89.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $370.00 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:
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Drug Coverage
The Humana Essentials Plus Giveback H5216-358 (PPO) plan features an annual drug deductible of $390. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and preferred mail-order services, while standard mail-order costs up to $30 for a three-month supply. Tier 2 generic drugs cost as low as a $1 copay for a one-month supply, with no copay required for three-month orders filled through preferred mail-order. Tier 3 preferred brand drugs require a $30 copay for a one-month supply at standard pharmacies or preferred mail-order, with standard mail-order copays rising to $47. Higher-tier prescriptions are subject to coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring a 37% coinsurance across all fulfillment methods. Tier 5 specialty drugs are limited to a one-month supply and incur a 28% coinsurance at standard pharmacies as well as both preferred and standard mail-order.
Additional Benefits
The Humana Essentials Plus Giveback H5216-358 (PPO) plan provides comprehensive healthcare coverage featuring no copay for primary care visits, preventive screenings, and routine vision and dental services. For specialized medical needs, members will pay a $40 copay for specialist visits, a $310 daily copay for the first few days of inpatient hospital stays, and a $115 copay for emergency room visits. Outpatient hospital services range from no copay up to a $350 copay, while diagnostic lab tests and outpatient X-rays are available with no copay. This plan also includes key supplemental benefits, offering routine hearing and vision exams with no copay, alongside dental coverage up to a $1,500 annual limit with no copay for most covered services. Medical equipment and dialysis services are covered with coinsurance ranging from 10% to 20% and no copay, while skilled nursing facility stays require no copay for the first 20 days. Additionally, members can access covered home health services and home infusion bundled services with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Humana Essentials Plus Giveback H5216-358 (PPO) with no coinsurance, requiring a $310 daily copay for days 1-7 of an acute stay or days 1-6 of a psychiatric stay, and no copay for remaining covered days. Prior authorization is required, and hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Essentials Plus Giveback H5216-358 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $310 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services require a $30 to $35 copay per session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by the Humana Essentials Plus Giveback H5216-358 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H5216-358 (PPO) covers emergency ambulance services with a $335 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Essentials Plus Giveback H5216-358 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for a $115 copay and no coinsurance.
Primary Care See details
Humana Essentials Plus Giveback H5216-358 (PPO) partially covers primary care benefits with no coinsurance across all covered services, featuring primary care visits with no copay and specialist visits with a $40 copay. Physical and occupational therapy require a $25 copay, mental health sessions cost a $30 copay, and chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Essentials Plus Giveback H5216-358 (PPO) covers preventive services, including annual physical exams, kidney disease education, and various screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered, offering a memory fitness program with no copay but excluding health education, personal emergency response systems, nutritional training, weight management, and in-home safety assessments.
Hearing Services See details
Humana Essentials Plus Giveback H5216-358 (PPO) covers hearing services with no deductible, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Essentials Plus Giveback H5216-358 (PPO), offering one routine eye exam and eyewear (contacts or complete eyeglasses) per year with no copay, no coinsurance, and no deductible. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
Humana Essentials Plus Giveback H5216-358 (PPO) partially covers dental services up to a $1,500 combined annual limit, with a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services. Under this plan, fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Essentials Plus Giveback H5216-358 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs carry no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Essentials Plus Giveback H5216-358 (PPO) 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 H5216-358 (PPO) covers medical equipment, featuring durable medical equipment with a 15% coinsurance and no copay, and prosthetics and medical supplies with a 10% 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
Diagnostic and radiological services are covered by Humana Essentials Plus Giveback H5216-358 (PPO) with no coinsurance for diagnostic services, and no copay for lab services and outpatient X-rays. Diagnostic procedures and tests carry a copay ranging from $0 to $175, while therapeutic radiological services require a minimum 20% coinsurance and a $40 copay.
Home Health Services See details
Home health services are covered under the Humana Essentials Plus Giveback H5216-358 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Humana Essentials Plus Giveback H5216-358 (PPO) with no coinsurance, though prior authorization is required. Some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice and require copays between $15 and $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Essentials Plus Giveback H5216-358 (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. This benefit features no copay for days 1 through 20 and a $218 copay per day for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Essentials Plus Giveback H5216-358 (PPO) provides partially covered other services, which include acupuncture with a $40 copay and no coinsurance for up to 20 treatments yearly, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan, and prior authorization is required for the covered services.
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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.
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