Humana Essentials Plus Giveback H5216-405 (PPO)

Humana Essentials Plus Giveback H5216-405 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Kansas City, MO-KS. 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 H5216-405 (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 H5216-405 (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.

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:

Drug Coverage

The Humana Essentials Plus Giveback H5216-405 (PPO) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will 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 as little as no copay for a 3-month supply via preferred mail order, or a $10 copay for a 1-month supply at standard pharmacies. Tier 3 preferred brand drugs require a copay of $47 for a 1-month supply, with savings available on 3-month supplies through preferred mail order. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 48% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. Understanding these copayments and coinsurance rates helps you estimate your out-of-pocket prescription drug costs with this Humana PPO plan.

Additional Benefits

The Humana Essentials Plus Giveback H5216-405 (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, physical therapy, and mental health services, members pay a $30 copay with no coinsurance. Inpatient hospital stays require a daily copay of $375 for the first seven days of acute care, while emergency room visits carry a $130 copay that is waived if you are admitted. This plan also features strong dental, vision, and hearing benefits, including no copay for routine eye and hearing exams, alongside a combined $2,500 annual limit for dental services with no copay for most preventive care. Diagnostic services such as X-rays and diagnostic radiology require no copay and no coinsurance, while durable medical equipment and dialysis services carry a 20% coinsurance with no copay. Additionally, members can access acupuncture with a $30 copay, as well as over-the-counter items and meal benefits with no copay.