Humana Essentials Plus Giveback (PPO)

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Monthly Premium

Humana Essentials Plus Giveback (PPO) is a PPO plan offered by Humana Inc.

Plan ID: H7617-100

HelpAdvisor Editorial Team analysis of data from the 2027 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as Humana Essentials Plus Giveback (PPO) - H7617-100 by Humana Inc. as well as other Medicare Advantage plans available in your area.

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Monthly Premium

Delaware Counties Served

New Castle Sussex

Basic Costs and Coverage

Coverage	Cost
Drug Deductible	$700
Out of Pocket Max	In-Network: $9850 Out-of-Network: N/A
Initial Coverage Limit	$0
Catastrophic Coverage Limit	$2100
Primary Care Doctor Visit	Out-of-Network: Doctor Office Visit Services: Coinsurance for Medicare Covered Primary Care Office Visit $25%
Specialty Doctor Visit	Out-of-Network: Doctor Specialty Visit Services: Coinsurance for Medicare Covered Physician Specialist Office Visit $30%
Inpatient Hospital Care	Out-of-Network: Acute Hospital Services: Coinsurance for Acute Hospital Services per Stay 50%
Urgent Care	Urgent Care: Copayment for Urgent Care $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $40
Emergency Room Visit	Emergency Care: Copayment for Emergency Care $115 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $115 Copayment for Worldwide Emergency Transportation $325
Ambulance Transportation	In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $325 Air Ambulance: Coinsurance for Air Ambulance Services $20% Prior Authorization Required for Air Ambulance

Health Care Services and Medical Supplies

Humana Essentials Plus Giveback (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage	Cost
Chiropractic Services	Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 35% In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 Prior Authorization Required for Chiropractic Services
Diabetes Supplies, Training, Nutrition Therapy and Monitoring	Out-of-Network: Diabetic Supplies and Services: Coinsurance for Medicare Covered Diabetic Supplies 50% Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 50%
Durable Medical Equipment (DME)	In-Network: Durable Medical Equipment: Coinsurance for Medicare-covered Durable Medical Equipment 12% Prior Authorization Required for Durable Medical Equipment
Diagnostic Tests, Lab and Radiology Services, and X-Rays	In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $180 Copayment for Medicare-covered Lab Services $0 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services $180 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$40 OP Diag Proc & Tests - SPC$40 OP Diag Proc & Tests - UCC$175 Sleep Study (Fac Based) - OPH$100 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 to $345 Copayment for Medicare-covered Therapeutic Radiological Services $40 Coinsurance for Medicare-covered Therapeutic Radiological Services 20% Copayment for Medicare-covered X-Ray Services $0 to $145
Home Health Care	Out-of-Network: Home Health Services: Coinsurance for Medicare Covered Home Health 50%
Mental Health Inpatient Care	In-Network: Psychiatric Hospital Services: $345 per day for days 1 to 5 $0 per day for days 6 to 90 Prior Authorization Required for Psychiatric Hospital Services
Mental Health Outpatient Care	Out-of-Network: Mental Health Services: Coinsurance for Medicare Covered Individual Sessions 30% Coinsurance for Medicare Covered Group Sessions 30%
Outpatient Services / Surgery	In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $475 Prior Authorization Required for Outpatient Hospital Services $0 Diag Colonoscopy - OPH$35 Mental Health - OPH$475 Surgery Svcs - OPH$40 Wound Care - OPH Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $345 Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 to $400 Prior Authorization Required for Ambulatory Surgical Center Services $0 Diag Colonoscopy - ASC$400 Surgery Svcs - ASC
Outpatient Substance Abuse Care	Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 30% to 50% Coinsurance for Medicare Covered Group Sessions 30% to 50% In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $35 Copayment for Medicare-covered Group Sessions $35 Prior Authorization Required for Outpatient Substance Abuse Services
Podiatry Services	In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $40 Prior Authorization Required for Podiatry Services Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 30%
Skilled Nursing Facility Care	In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $221 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services

Dental Benefits

The following dental services are covered from in-network providers.

Coverage	Cost
Dental Care	In-Network: 0% coinsurance for crown recementation up to 1 every 2 years. 0% coinsurance for root canal retreatment up to 1 per tooth per lifetime. 0% coinsurance for bridge recementation up to 1 per year. 0% coinsurance for oral surgery up to 2 per year. 0% coinsurance for periodontal maintenance up to 4 per year. $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays up to 1 per year. $0 copayment for emergency diagnostic exam, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for intraoral x-rays up to 6 per year. 50% coinsurance for amalgam and/or composite filling up to 1 per tooth per surface every 2 years. 50% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. 50% coinsurance for occlusal adjustment up to 1 every 3 years. 50% coinsurance for crown-porcelain fused to high noble metal, crown-porcelain fused to noble metal, crown-porcelain/ceramic, denture repair - additions, other restorative services - core buildup and prefabricated post and core up to 1 per tooth every 5 years. 50% coinsurance for bridges-pontic, complete dentures, partial dentures up to 1 every 5 years. 50% coinsurance for bridges-crown-porcelain fused to high noble metal, bridges-crown-porcelain fused to noble metal, bridges-crown-porcelain/ceramic up to 2 every 5 years. 50% coinsurance per tooth for root canal, simple or surgical extraction up to 1 per lifetime. 50% coinsurance for necessary nitrous oxide/analgesia with covered service up to 1 unit(s) per visit. 50% coinsurance for denture rebase, denture reline, scaling for moderate inflammation, tissue conditioning up to 1 per year. 50% coinsurance for denture repair - broken teeth up to 2 per tooth per year. 50% coinsurance for adjustments to dentures, denture repair - base and framework, emergency treatment for pain, necessary general anesthesia with covered service up to 2 per year. 50% coinsurance for necessary incremental anesthesia with covered service up to as needed with covered codes per year. $500 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. Out-of-Network: 0% coinsurance for crown recementation up to 1 every 2 years. 0% coinsurance for root canal retreatment up to 1 per tooth per lifetime. 0% coinsurance for bridge recementation up to 1 per year. 0% coinsurance for oral surgery up to 2 per year. 0% coinsurance for periodontal maintenance up to 4 per year. $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays up to 1 per year. $0 copayment for emergency diagnostic exam, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for intraoral x-rays up to 6 per year. 50% coinsurance for amalgam and/or composite filling up to 1 per tooth per surface every 2 years. 50% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. 50% coinsurance for occlusal adjustment up to 1 every 3 years. 50% coinsurance for crown-porcelain fused to high noble metal, crown-porcelain fused to noble metal, crown-porcelain/ceramic, denture repair - additions, other restorative services - core buildup and prefabricated post and core up to 1 per tooth every 5 years. 50% coinsurance for bridges-pontic, complete dentures, partial dentures up to 1 every 5 years. 50% coinsurance for bridges-crown-porcelain fused to high noble metal, bridges-crown-porcelain fused to noble metal, bridges-crown-porcelain/ceramic up to 2 every 5 years. 50% coinsurance per tooth for root canal, simple or surgical extraction up to 1 per lifetime. 50% coinsurance for necessary nitrous oxide/analgesia with covered service up to 1 unit(s) per visit. 50% coinsurance for denture rebase, denture reline, scaling for moderate inflammation, tissue conditioning up to 1 per year. 50% coinsurance for denture repair - broken teeth up to 2 per tooth per year. 50% coinsurance for adjustments to dentures, denture repair - base and framework, emergency treatment for pain, necessary general anesthesia with covered service up to 2 per year. 50% coinsurance for necessary incremental anesthesia with covered service up to as needed with covered codes per year. $500 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions.

Coverage

Cost

Dental Care

In-Network:
0% coinsurance for crown recementation up to 1 every 2 years.
0% coinsurance for root canal retreatment up to 1 per tooth per lifetime.
0% coinsurance for bridge recementation up to 1 per year.
0% coinsurance for oral surgery up to 2 per year.
0% coinsurance for periodontal maintenance up to 4 per year.
$0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years.
$0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years.
$0 copayment for bitewing x-rays up to 1 per year.
$0 copayment for emergency diagnostic exam, periodic oral exam, prophylaxis (cleaning) up to 2 per year.
$0 copayment for intraoral x-rays up to 6 per year.
50% coinsurance for amalgam and/or composite filling up to 1 per tooth per surface every 2 years.
50% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years.
50% coinsurance for occlusal adjustment up to 1 every 3 years.
50% coinsurance for crown-porcelain fused to high noble metal, crown-porcelain fused to noble metal, crown-porcelain/ceramic, denture repair - additions, other restorative services - core buildup and prefabricated post and core up to 1 per tooth every 5 years.
50% coinsurance for bridges-pontic, complete dentures, partial dentures up to 1 every 5 years.
50% coinsurance for bridges-crown-porcelain fused to high noble metal, bridges-crown-porcelain fused to noble metal, bridges-crown-porcelain/ceramic up to 2 every 5 years.
50% coinsurance per tooth for root canal, simple or surgical extraction up to 1 per lifetime.
50% coinsurance for necessary nitrous oxide/analgesia with covered service up to 1 unit(s) per visit.
50% coinsurance for denture rebase, denture reline, scaling for moderate inflammation, tissue conditioning up to 1 per year.
50% coinsurance for denture repair - broken teeth up to 2 per tooth per year.
50% coinsurance for adjustments to dentures, denture repair - base and framework, emergency treatment for pain, necessary general anesthesia with covered service up to 2 per year.
50% coinsurance for necessary incremental anesthesia with covered service up to as needed with covered codes per year.
$500 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.

Out-of-Network:
0% coinsurance for crown recementation up to 1 every 2 years.
0% coinsurance for root canal retreatment up to 1 per tooth per lifetime.
0% coinsurance for bridge recementation up to 1 per year.
0% coinsurance for oral surgery up to 2 per year.
0% coinsurance for periodontal maintenance up to 4 per year.
$0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years.
$0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years.
$0 copayment for bitewing x-rays up to 1 per year.
$0 copayment for emergency diagnostic exam, periodic oral exam, prophylaxis (cleaning) up to 2 per year.
$0 copayment for intraoral x-rays up to 6 per year.
50% coinsurance for amalgam and/or composite filling up to 1 per tooth per surface every 2 years.
50% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years.
50% coinsurance for occlusal adjustment up to 1 every 3 years.
50% coinsurance for crown-porcelain fused to high noble metal, crown-porcelain fused to noble metal, crown-porcelain/ceramic, denture repair - additions, other restorative services - core buildup and prefabricated post and core up to 1 per tooth every 5 years.
50% coinsurance for bridges-pontic, complete dentures, partial dentures up to 1 every 5 years.
50% coinsurance for bridges-crown-porcelain fused to high noble metal, bridges-crown-porcelain fused to noble metal, bridges-crown-porcelain/ceramic up to 2 every 5 years.
50% coinsurance per tooth for root canal, simple or surgical extraction up to 1 per lifetime.
50% coinsurance for necessary nitrous oxide/analgesia with covered service up to 1 unit(s) per visit.
50% coinsurance for denture rebase, denture reline, scaling for moderate inflammation, tissue conditioning up to 1 per year.
50% coinsurance for denture repair - broken teeth up to 2 per tooth per year.
50% coinsurance for adjustments to dentures, denture repair - base and framework, emergency treatment for pain, necessary general anesthesia with covered service up to 2 per year.
50% coinsurance for necessary incremental anesthesia with covered service up to as needed with covered codes per year.
$500 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.
Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions.

Vision Benefits

The following vision services are covered from in-network providers.

Coverage	Cost
Vision Benefits	In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 to $40 Copayment for Routine Eye Exams $0 Maximum 1 Routine Eye Exams every year Prior Authorization Required for Eye Exams $0 Diab Eye Exam - All POTs$40 Vision Svcs (MC) - SPC Eyewear: Copayment for Medicare-Covered Benefits $0 Copayment for Contact Lenses $0 Maximum 1 Pair every year Copayment for Eyeglasses (lenses and frames) $0 Maximum 1 Pair every year Maximum Plan Benefit of $100 every year Members must use Humana's Medicare Insight Network, a national network of providers, which includes standard or PLUS providers. The allowance for the standard network is $50 less than the PLUS network.

Coverage

Cost

Vision Benefits

In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0 to $40
Copayment for Routine Eye Exams $0

Maximum 1 Routine Eye Exams every year

Prior Authorization Required for Eye Exams
$0 Diab Eye Exam - All POTs$40 Vision Svcs (MC) - SPC

Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0

Maximum 1 Pair every year

Copayment for Eyeglasses (lenses and frames) $0

Maximum 1 Pair every year

Maximum Plan Benefit of $100 every year
Members must use Humana's Medicare Insight Network, a national network of providers, which includes standard or PLUS providers. The allowance for the standard network is $50 less than the PLUS network.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage	Cost
Hearing Benefits	In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $40 Copayment for Routine Hearing Exams $0 Maximum 1 visit every year Copayment for Fitting/Evaluation for Hearing Aid $0 Maximum 4 visits every year Prior Authorization Required for Hearing Exams Hearing Aids: Copayment for Hearing Aids $575 to $750 Maximum 2 Hearing Aids every year

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage	Cost
Preventive Services and Health/Wellness Education Programs	Out-of-Network: Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0

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