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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 $64.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $100.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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, allowing your prescription coverage to begin immediately. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for 1-month or 3-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order for these generic tiers ranges from a $10 to $20 copay for a 1-month supply. Tier 3 preferred brand drugs have a $30 copay for a 1-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. For higher-tier medications, Tier 4 non-preferred drugs require a 35% coinsurance across standard pharmacies and mail order options. Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply.
Additional Benefits
The Humana Essentials Plus Giveback H5216-435 (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, routine physical exams, and home health services. For specialist visits, members pay a $50 copay, while emergency care has a $115 copay. Inpatient hospital stays require a $325 daily copay for the first six days, after which there is no copay for days seven through 90. Ancillary benefits include routine vision and dental care with no copay and no coinsurance, including up to $2,000 annually for preventive and comprehensive dental services. Routine hearing exams also feature no copay, though prescription hearing aids require copays between $699 and $999. Durable medical equipment is covered with a 15% coinsurance and no copay, ensuring affordable access to necessary medical devices.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Essentials Plus Giveback H5216-435 (PPO) with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90 for both acute and psychiatric stays. Unlimited additional acute hospital 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 for most care. Outpatient hospital services have a copay of $0 to $325, outpatient substance abuse sessions require a $25 to $35 copay, and both ambulatory surgical center and blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Essentials Plus Giveback H5216-435 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, with no coinsurance required for either service. While transportation benefits are technically included, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay 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 covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Humana Essentials Plus Giveback H5216-435 (PPO) feature primary care physician visits with no copay and no coinsurance, and specialist visits with a $50 copay and no coinsurance. Therapy, mental health, and podiatry services are covered with copays ranging from $25 to $35 and no coinsurance, while routine chiropractic services are not covered.
Preventive Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) offers partially covered preventive services with no copay and no coinsurance for covered benefits such as annual physical exams, glaucoma screenings, and diabetes self-management. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) provides partially covered hearing services, including Medicare-covered exams for a $50 copay and no coinsurance, and routine annual exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $699 to $999 and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) offers partially covered vision services with no deductible, no coinsurance, and no copays for annual routine eye exams and select eyewear like eyeglasses or contact lenses. Other eye exam services, separate eyeglass lenses or frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Essentials Plus Giveback H5216-435 (PPO) up to a $2,000 yearly maximum, offering no copay and no coinsurance for preventive care, restorative care, endodontics, periodontics, and oral surgery. Prosthodontics are covered with no copay and a 30% coinsurance, Medicare-covered dental has a $50 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics 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. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, are covered with a coinsurance ranging from 0% to 20%, while Medicare Part B insulin specifically features a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers durable medical equipment (DME) with a 15% coinsurance and no copay. Prosthetics and medical supplies are covered with a 15% to 20% coinsurance and no copay, while diabetic supplies and services require a 10% to 20% coinsurance with no copay, or a $10 copay for therapeutic shoes and inserts.
Diagnostic and Radiological Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers diagnostic and radiological services with no copay for lab services, diagnostic radiology, and outpatient X-rays, though some coinsurance may apply. Diagnostic procedures and tests have a copay of up to $50 and a minimum 20% coinsurance, while therapeutic radiological services require a minimum $50 copay and 20% coinsurance.
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
Humana Essentials Plus Giveback H5216-435 (PPO) indicates that some cardiac rehabilitation services are covered, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Because these key services are not covered, there are no applicable copayments or coinsurance costs for them under this plan.
Skilled Nursing Facility (SNF) See details
Humana Essentials Plus Giveback H5216-435 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Humana Essentials Plus Giveback H5216-435 (PPO) partially covers other services, offering acupuncture for a $50.00 copay and no coinsurance up to 20 treatments per year, alongside chronic illness meals with no copay and no coinsurance. Both of these covered services require prior authorization, while over-the-counter (OTC) items are not covered.
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