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Humana Essentials Plus Giveback H5216-429 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H5216-429 (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 H5216-429 (PPO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H5216-429 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in ID. 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 H5216-429 (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 H5216-429 (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 H5216-429 (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 $77.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $285.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 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 H5216-429 (PPO) plan has an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $1 copay for a 1-month supply at standard pharmacies and preferred mail order, with no copay required for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, which goes up to $141 for a 3-month supply at standard pharmacies. For higher-tier medications, you will pay coinsurance instead of a flat copay. Tier 4 non-preferred drugs require a 38% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Essentials Plus Giveback H5216-429 (PPO) plan offers robust coverage for core medical services with predictable out-of-pocket costs. Routine care is highly affordable, featuring no copay for primary care visits and preventive services, while specialist visits require a $35 copay. For more intensive care, inpatient hospital stays require a daily copay of $450 for the first five days and no copay thereafter, while emergency room visits carry a $115 copay. This plan also includes valuable supplemental coverage, including routine dental care with no copay up to a $1,000 annual limit. Vision services feature no copay for eyewear up to a $100 annual allowance, and routine hearing exams are also provided with no copay. Other essential benefits like home health services require no copay, while durable medical equipment is covered with a 14% coinsurance.
Inpatient Hospital See details
Humana Essentials Plus Giveback H5216-429 (PPO) inpatient hospital services are partially covered with no coinsurance, though prior authorization is required. For acute care, there is a $450 daily copay for days 1 to 5 and no copay for days 6 and beyond, excluding upgrades and non-Medicare-covered stays. For psychiatric care, there is a $416 daily copay for days 1 to 5 and no copay for days 6 to 90, excluding additional days and non-Medicare-covered stays.
Outpatient Services See details
Humana Essentials Plus Giveback H5216-429 (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services range from no copay to a $450 copay (with a $450 copay per stay for observation services), while outpatient substance abuse sessions range from no copay to a $35 copay.
Partial Hospitalization See details
Humana Essentials Plus Giveback H5216-429 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H5216-429 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both requiring prior authorization with no coinsurance. Routine transportation services, including trips to plan-approved or other health-related locations, are not covered.
Emergency Services See details
Humana Essentials Plus Giveback H5216-429 (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 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 H5216-429 (PPO) primary care benefits include primary care physician visits with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, while podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are covered by the Humana Essentials Plus Giveback H5216-429 (PPO) plan with no copay and no coinsurance for services like annual physicals, kidney disease education, glaucoma screenings, and memory fitness. This benefit is partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, and therapeutic massage. Also excluded are adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Essentials Plus Giveback H5216-429 (PPO) covers hearing services, offering Medicare-covered exams for a $35 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Essentials Plus Giveback H5216-429 (PPO) provides partially covered vision services with no deductibles and no coinsurance, offering a $0 to $35 copay for eye exams and no copay for contacts or eyeglasses up to a $100 annual limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Essentials Plus Giveback H5216-429 (PPO) offers partially covered dental services featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $1,000 annual limit. Routine preventive and comprehensive services are covered, but 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 H5216-429 (PPO) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance with no copay, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Essentials Plus Giveback H5216-429 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Humana Essentials Plus Giveback H5216-429 (PPO) covers medical equipment, including durable medical equipment and prosthetics, with a 14% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and applicable coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Humana Essentials Plus Giveback H5216-429 (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, no copay for lab services, and a copay ranging from $0 to $55 for procedures, while radiological services require a 20% coinsurance for therapeutic services and no copay for outpatient X-rays and diagnostic radiological services.
Home Health Services See details
Home health services are covered under the Humana Essentials Plus Giveback H5216-429 (PPO) plan 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 H5216-429 (PPO) with no coinsurance, though only some services are covered as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These services require prior authorization and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Humana Essentials Plus Giveback H5216-429 (PPO) with no coinsurance and prior authorization required, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and days 86 through 100, while days 21 through 85 require a $218 daily copay.
Other Services See details
Humana Essentials Plus Giveback H5216-429 (PPO) provides partial coverage for other services, featuring acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year, alongside a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items and other miscellaneous services are not covered under this benefit.
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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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