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Humana Essentials Plus Giveback H5216-430 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H5216-430 (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 H5216-430 (PPO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H5216-430 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in UT. 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 H5216-430 (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 H5216-430 (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 H5216-430 (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 $180.00 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 $9450.00 (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 $9450.00 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 H5216-430 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using standard pharmacies or preferred mail order for one-month and three-month supplies. Tier 2 generic drugs require a $5 copay for a one-month supply at standard pharmacies and preferred mail order, though a three-month preferred mail order has no copay. Tier 3 preferred brand drugs cost a $47 copay for a one-month supply at standard pharmacies and mail-order services. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 38% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. These cost-sharing details help you understand your potential out-of-pocket costs under this Humana Medicare PPO plan.
Additional Benefits
The Humana Essentials Plus Giveback H5216-430 (PPO) plan offers comprehensive coverage for core medical needs, often featuring no coinsurance for key services. Patients benefit from no copay for primary care visits, while specialist visits require a $40 copay and inpatient hospital stays carry a $395 daily copay for the first five days. Emergency room visits have a $115 copay, which is waived if you are admitted, and urgent care services require a $40 copay. For routine wellness, the plan provides no copay for annual vision and hearing exams, alongside a $1,000 annual maximum allowance for preventive and comprehensive dental care. Standard diagnostic lab tests and home health services are also fully covered with no copay or coinsurance. While many benefits require no coinsurance, certain items like durable medical equipment and dialysis require a 15% to 20% coinsurance.
Inpatient Hospital See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $395 copay per day for days 1 to 5 and no copay for days 6 to 90. Acute care includes unlimited additional days at no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers outpatient services with no coinsurance, though prior authorization is required. Outpatient hospital and observation services have a copay of $0 to $395, outpatient substance abuse services have a copay of $0 to $35, and both ambulatory surgical center and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both with no coinsurance. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Humana Essentials Plus Giveback H5216-430 (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 care, and emergency transportation are all covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers primary care visits, mental health, and psychiatric services with no copay and no coinsurance. Specialist visits require a $40 copay, while physical, occupational, and speech therapies have a $25 copay, all with no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Essentials Plus Giveback H5216-430 (PPO) offers partially covered preventive services with no copay and no coinsurance for covered benefits, which include annual physicals, kidney disease education, glaucoma screenings, diabetes self-management, and memory fitness. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered under the Humana Essentials Plus Giveback H5216-430 (PPO), featuring no copay and no coinsurance for one annual routine exam and unlimited fitting evaluations, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance for up to two aids per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Essentials Plus Giveback H5216-430 (PPO), featuring routine eye exams with no copay and no coinsurance up to a $75 annual limit, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $150 annual limit for contact lenses or complete eyeglasses, while standalone lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services under the Humana Essentials Plus Giveback H5216-430 (PPO) plan are partially covered, offering up to a $1,000 annual maximum benefit for both in- and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from 0% to 20%, with insulin drugs requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by Humana Essentials Plus Giveback H5216-430 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 15% coinsurance and no copay. Covered diabetic supplies have a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $50 copay for other diagnostic tests. Covered radiological services include outpatient X-rays and diagnostic radiology starting at no copay, while therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Essentials Plus Giveback H5216-430 (PPO) offers cardiac rehabilitation services with no coinsurance, requiring prior authorization. While some services are covered, specific options like cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Humana Essentials Plus Giveback H5216-430 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 86 to 100, a $218 daily copay for days 21 to 85, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Humana Essentials Plus Giveback H5216-430 (PPO) partially covers other services, offering acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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