The H5216-405 is the Humana Essentials Plus Giveback PPO plan. It offers $0 monthly premium and pays $70 toward your Part B premium.
This plan serves select counties in Kansas and Missouri.
Quick Summary:
- $0 monthly premium with $70 Part B giveback benefit
- PPO plan—see any provider, lower costs in-network
- $5,000 max out-of-pocket limit (in-network)
- Includes drug coverage with $615 annual deductible
- Available in Kansas and Missouri counties only
- Contract ID H5216, Plan ID 405
Overview of the H5216-405 Plan
The H5216-405 plan is a Medicare Advantage PPO offered by Humana Insurance Company. PPO stands for Preferred Provider Organization.
Plan Type: Local PPO (Part C with prescription drug coverage)
Insurance Carrier: Humana Insurance Co. (Contract H5216)
The H5216 contract includes multiple plan options for different needs. If this PPO doesn’t fit your budget, check H5216-345 for lower copays, or H5216-420 if you need broader drug coverage.
Service Area:
- Kansas: Johnson, Wyandotte, Shawnee, Douglas, Leavenworth, Miami, and other select counties
- Missouri: Clay, Jackson, Platte, Ray, Lafayette counties
This plan combines medical and drug benefits into one package. You must have Medicare Part A and Part B to enroll.
What Does the H5216-405 Plan Cover?
The H5216-405 plan covers all standard Medicare services plus extras. Here’s a breakdown of medical benefits, drug coverage, and bonus perks.
Medical Benefits
The plan covers all Medicare-approved services. Here’s what you pay:
| Service | In-Network Cost |
|---|---|
| Primary Care Visit | $0 copay |
| Specialist Visit | $45 copay |
| Inpatient Hospital | $375/day (Days 1–7), $0/day (Days 8–90) |
| Emergency Room | Varies by service |
| Lab Tests | $0 copay (most services) |
Drug Coverage (Part D)
The plan includes prescription drug coverage. You’ll pay a $615 annual deductible for Tiers 1–3 drugs in 2026.
Note: Deductible amounts can change yearly. The 2025 plan had different tier rules. Always check your year’s Summary of Benefits.
Extra Benefits
- Part B Premium Reduction: $70 per month giveback
- OTC Allowance: $50 every quarter for over-the-counter items
- Preventive Care: $0 cost for Medicare-covered screenings
- Additional perks may include: Dental, vision, hearing, or fitness programs (check current year benefits)
Costs and Premiums
Understanding your costs helps you budget for healthcare expenses. The H5216-405 plan offers low upfront costs with strong financial protection.
Monthly Premium
Plan Premium: $0.00
Part B Giveback: $70.00 per month
This means Humana pays $70 toward your Medicare Part B premium each month. You still pay the remaining Part B amount to Medicare.
Example:
- Standard Part B premium in 2026: $185
- Your giveback: $70
- You pay: $115 per month for Part B
Copays and Coinsurance
Most services have fixed copays. Some services use coinsurance (a percentage of the cost).
Common Copays:
- Primary doctor: $0
- Specialist: $45
- Hospital stay: $375/day (first 7 days)
Out-of-Pocket Maximum
In-Network Max: $5,000 per year
Combined (In + Out-of-Network) Max: $10,100 per year
Once you reach this limit, the plan pays 100% of covered costs. This protects you from high medical bills.
Provider Network & Flexibility
PPO plans give you more freedom than HMO plans. You can choose where to get care and how much you spend.
In-Network vs Out-of-Network Rules
As a PPO plan, you can see any Medicare-approved provider. You don’t need referrals to see specialists.
In-Network:
- Lower copays and coinsurance
- Predictable costs
- Larger provider selection in your area
Out-of-Network:
- Higher costs for most services
- Still covered, but you pay more
- Useful when traveling or seeing specific doctors
Referrals Required?
No. You can see specialists without a referral. This gives you more control over your healthcare choices.
Who Is This Plan Best For?
This plan works well if you:
- Live in Kansas or Missouri service counties
- Want to reduce your Part B premium costs
- Prefer flexibility to see any doctor
- Need prescription drug coverage
- Want predictable copays for doctor visits
- Don’t want to pay a monthly premium
Not ideal if:
- You live outside the service area
- You need very expensive specialty drugs (check formulary)
- You want a plan with lower out-of-pocket max
Always compare plans based on your health needs and budget.
How to Check Availability in Your ZIP Code
Follow these steps to confirm H5216-405 is available where you live:
- Visit Medicare.gov/plan-compare
- Enter your ZIP code and county
- Answer a few health questions
- Look for plan H5216-405 in results
- Compare costs and benefits side-by-side
You can also call Humana directly at 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.
Enrollment Periods:
- Annual Enrollment: October 15 – December 7
- Medicare Advantage Open Enrollment: January 1 – March 31
Compare With Other H5216 Plans
Humana offers other plans under the H5216 contract:
- H5216-345: Lower out-of-pocket maximums with $0 premium
- H5216-420: Enhanced drug coverage and dental benefits
- Other H5216 plans may have different service areas or HMO network structures
Visit Medicare.gov or Humana.com to view all available plans in your area.
Frequently Asked Questions (FAQs)
1. What does the H5216-405 plan giveback cover?
The $70 monthly giveback reduces your Medicare Part B premium. Humana pays this amount directly. You still pay the remaining Part B cost to Medicare each month.
2. Can I use H5216-405 if I live outside Kansas or Missouri?
No. This plan only serves specific counties in Kansas and Missouri. Check Medicare.gov to find plans available in your ZIP code.
3. Does H5216-405 require referrals to see specialists?
No. As a PPO plan, you can see any specialist without a referral. You’ll pay less when using in-network providers.
4. What is the drug deductible for H5216-405 in 2026?
The prescription drug deductible is $615 annually. This applies to Tiers 1–3 medications. Always verify details in your plan’s Summary of Benefits.
5. How do I enroll in the H5216-405 Medicare Advantage plan?
Enroll during Annual Enrollment (Oct 15–Dec 7) or Medicare Advantage Open Enrollment (Jan 1–Mar 31). Call 1-800-MEDICARE or visit Medicare.gov/plan-compare to enroll.
6. Does H5216-405 include dental and vision coverage?
Many Humana Medicare Advantage plans include extra benefits like dental, vision, and hearing. Check your year’s Summary of Benefits or call Humana for specific coverage details.
Final Thoughts
The H5216-405 Humana Essentials Plus Giveback PPO offers great value. You get $0 premium, Part B savings, and flexible provider options.
Always review the plan’s Summary of Benefits each year. Costs and coverage can change.
Ready to enroll? Visit Medicare.gov or call 1-800-MEDICARE today.
