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Humana Essentials Plus Giveback H5216-435 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H5216-435 (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 H5216-435 (PPO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H5216-435 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in AZ, CO, NM. 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 H5216-435 (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 H5216-435 (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 H5216-435 (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 $79.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
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 H5216-435 (PPO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for a 1-month or 3-month supply when using standard pharmacies or preferred mail order. If you choose standard mail order for these tiers, 1-month copays are $10 for Tier 1 and $20 for Tier 2. For Tier 3 preferred brand drugs, you will pay a $30 copay for a 1-month supply at standard pharmacies and preferred mail order, or $47 through standard mail order. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 35% coinsurance and Tier 5 specialty drugs requiring a 33% coinsurance. This structured coverage makes it easy to understand your out-of-pocket costs for various prescription drug tiers.
Additional Benefits
The Humana Essentials Plus Giveback H5216-435 (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $325 daily copay for days 1 through 6, with no copay for subsequent days up to day 90. Outpatient hospital services require no coinsurance and carry a copay ranging from no copay up to $325. Supplemental benefits include dental care covered up to a $1,000 annual limit with no copay for most preventive services, and routine eye exams and eyewear with no copay. Routine hearing exams also feature no copay, while prescription hearing aids require a copay ranging from $699 to $999. For medical supplies, durable medical equipment is covered with a 15% coinsurance and no copay.
Inpatient Hospital See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers outpatient services with no coinsurance, though prior authorization is required. Outpatient hospital services carry a $0 to $325 copay, outpatient substance abuse sessions have a $25 to $35 copay, and ambulatory surgical center and blood services require no copay.
Partial Hospitalization See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Essentials Plus Giveback H5216-435 (PPO), offering ground ambulance services for a $335.00 copay and air ambulance services for a $1,250.00 copay, with no coinsurance for either service. Some transportation services are covered, but trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services under Humana Essentials Plus Giveback H5216-435 (PPO) are covered with a $115 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services have 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 H5216-435 (PPO) offers primary care physician services and select telehealth benefits with no copay and no coinsurance. Specialist visits, physical therapy, and mental health services are covered with copays ranging from $25 to $45 and no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are partially covered by Humana Essentials Plus Giveback H5216-435 (PPO) with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, diabetes training, and memory fitness. However, several supplemental services are not covered, such as health education, in-home safety assessments, nutritional therapy, weight management, alternative therapies, and counseling.
Hearing Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) partially covers hearing services, offering Medicare-covered exams for a $45 copay and no coinsurance, and routine exams or fitting evaluations for no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $699 to $999, but OTC, inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Essentials Plus Giveback H5216-435 (PPO) with no deductibles, no coinsurance, and copays ranging from $0 to $45 for eye exams and no copay for eyewear. The plan covers one routine eye exam (up to $75 annually) and one pair of eyeglasses or contact lenses (up to a combined $100 limit annually), but other eye exams, separate lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) provides partially covered dental services up to a $1,000 annual limit, with no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $45 copay and no coinsurance, prosthodontics require a 30% coinsurance and no copay, and fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may be required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers dialysis services with no copay and 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers durable medical equipment and medical supplies with a 15% coinsurance and no copay, and prosthetic devices with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Essentials Plus Giveback H5216-435 (PPO) with prior authorization, featuring no copay for lab services, outpatient X-rays, and diagnostic radiology. Diagnostic procedures carry a copay up to $50 and 20% coinsurance, while therapeutic radiology requires a $50 copay and 20% coinsurance, with coinsurance also applying to lab and X-ray services.
Home Health Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Humana Essentials Plus Giveback H5216-435 (PPO) require prior authorization, and while some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered. Pulmonary rehabilitation and SET for PAD services require a 20% coinsurance with no copay, while cardiac and intensive cardiac rehabilitation have no copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers skilled nursing facility (SNF) care with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) provides partial coverage for other services, including acupuncture for a $45 copay and no coinsurance (limited 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 plan.
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