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Humana Essentials Plus Giveback H7617-035 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Essentials Plus Giveback H7617-035 (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 H7617-035 (PPO) in 2026, please refer to our full plan details page.
Humana Essentials Plus Giveback H7617-035 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Texas. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Essentials Plus Giveback H7617-035 (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 H7617-035 (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 H7617-035 (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 $90.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $425.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $350.00 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 H7617-035 (PPO) Medicare plan features a $350 drug deductible before coverage begins. For Tier 1 preferred generic drugs, members pay no copay at standard pharmacies and through preferred mail order. Tier 2 generic medications cost as little as a $1 copay for a 1-month supply, and there is no copay for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $30 copay for a 1-month supply at standard pharmacies and preferred mail order. Higher-tier medications require coinsurance rather than a flat copay, with Tier 4 non-preferred drugs carrying a 37% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance.
Additional Benefits
The Humana Essentials Plus Giveback H7617-035 (PPO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. Specialist visits require a $40 copay, while emergency room visits carry a $115 copay that is waived upon hospital admission. For inpatient hospital stays, members pay a $310 daily copay for the first seven days of acute care and no copay for any remaining covered days. In addition to medical care, the plan provides dental benefits up to a $1,500 annual maximum and routine vision and hearing exams with no copay. Prescription hearing aids are covered with copays between $699 and $999, while durable medical equipment requires a 15% coinsurance and no copay. Furthermore, essential diagnostic services such as lab tests and outpatient X-rays are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services under the Humana Essentials Plus Giveback H7617-035 (PPO) are partially covered with no coinsurance, requiring a daily copay of $310 for days 1 through 7 of acute stays and days 1 through 6 of psychiatric stays, with no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Humana Essentials Plus Giveback H7617-035 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $350, observation services have a $310 copay per stay, and outpatient substance abuse sessions carry a copay of $30 to $35.
Partial Hospitalization See details
Humana Essentials Plus Giveback H7617-035 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Essentials Plus Giveback H7617-035 (PPO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground ambulance, and a 20% coinsurance and no copay for air ambulance. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Essentials Plus Giveback H7617-035 (PPO) covers emergency room visits 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 H7617-035 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Other covered benefits, including physical therapy ($25 copay), mental health sessions ($30 copay), and telehealth services ($0 to $40 copay), feature no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Humana Essentials Plus Giveback H7617-035 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs, and a memory fitness benefit. This benefit is partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Essentials Plus Giveback H7617-035 (PPO) provides partially covered hearing services, featuring a $40 copay and no coinsurance for Medicare-covered exams, while routine exams and fitting evaluations have no copay and no coinsurance. Up to two prescription hearing aids are covered annually with copays ranging from $699 to $999 and no coinsurance, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Humana Essentials Plus Giveback H7617-035 (PPO), offering no copay, no coinsurance, and no deductible for one routine eye exam and one pair of eyeglasses or contact lenses per year. There is a $75 annual limit for exams and a $150 combined annual limit for eyewear, but other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Essentials Plus Giveback H7617-035 (PPO), which features a $1,500 annual maximum with no copay and no coinsurance for preventive and most comprehensive services, and a $40 copay and no coinsurance for Medicare-covered dental. Specific services including fluoride treatment, removable prosthodontics, 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 H7617-035 (PPO) with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance of up to 20% (with no minimum coinsurance), with insulin specifically requiring a $35 copay.
Dialysis Services See details
Humana Essentials Plus Giveback H7617-035 (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 H7617-035 (PPO) covers medical equipment, including durable medical equipment (DME) with a 15% coinsurance and no copay. Prosthetics and medical supplies require a 10% coinsurance and no copay, diabetic supplies carry a 10% to 20% coinsurance and no copay, and diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Essentials Plus Giveback H7617-035 (PPO) with prior authorization required. Lab services, diagnostic radiological services, and outpatient X-rays feature no copay and no coinsurance, while diagnostic procedures have a $0 to $175 copay with no coinsurance, and therapeutic radiological services require a copay starting at $40 alongside 20% coinsurance.
Home Health Services See details
Humana Essentials Plus Giveback H7617-035 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no coinsurance under the Humana Essentials Plus Giveback H7617-035 (PPO) plan, requiring prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Essentials Plus Giveback H7617-035 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Humana Essentials Plus Giveback H7617-035 (PPO) partially covers other services, offering acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance, both requiring prior authorization. Over-the-counter (OTC) items are not covered under this benefit.
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