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Humana Essentials Plus Giveback (PPO) - H7617-056-000
$0.00
Monthly Premium
Humana Essentials Plus Giveback (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H7617-056-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
Arkansas and Oklahoma Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other additional benefits Original Medicare doesn’t cover.
Learn more about Arkansas and Oklahoma Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $700.00 |
| Out-of-pocket maximum | $7,925.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | Out-of-Network: Doctor Office Visit Services: Coinsurance for Medicare Covered Primary Care Office Visit 30% |
| Specialty doctor visit | Out-of-Network: Doctor Specialty Visit Services: Coinsurance for Medicare Covered Physician Specialist Office Visit 35% |
| Inpatient hospital care | In-Network: Acute Hospital Services: $395 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services |
| 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 | Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $325 Coinsurance for Medicare Covered Ambulance Services - Air 20% |
Health Care Services and Medical Supplies
Humana Essentials Plus Giveback (PPO) covers a range of additional benefits. Learn more about Humana Essentials Plus Giveback (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 35% |
| 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) | Out-of-Network: Durable Medical Equipment Services: Coinsurance for Medicare Covered Durable Medical Equipment 50% |
| Diagnostic tests, lab and radiology services, and X-rays | Out-of-Network: Diagnostic Procedures/Tests Services: Copayment for Medicare Covered Diagnostic Procedures/Tests $40 Coinsurance for Medicare Covered Diagnostic Procedures/Tests 30% to 50% Copayment for Medicare Covered Lab Services $40 Coinsurance for Medicare Covered Lab Services 50% Copayment for Medicare Covered Diagnostic Radiological Services $0 Coinsurance for Medicare Covered Diagnostic Radiological Services 50% Coinsurance for Medicare Covered Therapeutic Radiological Services 35% to 50% Copayment for Medicare Covered Outpatient X-Ray Services $40 Coinsurance for Medicare Covered Outpatient X-Ray Services 30% to 50% $100 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$35 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 |
| Home health care | In-Network: Home Health Services: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services |
| Mental health inpatient care | In-Network: Psychiatric Hospital Services: $345 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental health outpatient care | In-Network: Outpatient Mental Health Services: Copayment for Medicare-covered Individual Sessions $20 Copayment for Medicare-covered Group Sessions $20 |
| Outpatient services/surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $400 Prior Authorization Required for Outpatient Hospital Services $0 Diag Colonoscopy - OPH$20 Mental Health - OPH$400 Surgery Svcs - OPH$35 Wound Care - OPH Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $395 Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 to $325 Prior Authorization Required for Ambulatory Surgical Center Services $0 Diag Colonoscopy - ASC$325 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% |
| Podiatry services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $35 Prior Authorization Required for Podiatry Services |
| Skilled Nursing Facility (SNF) 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, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| 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. 30% coinsurance for amalgam and/or composite filling up to 1 per tooth per surface every 2 years. 30% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. 30% coinsurance for occlusal adjustment up to 1 every 3 years. 30% coinsurance for crown-porcelain fused to high noble metal, crown-porcelain fused to noble metal, crown-porcelain/ceramic, other restorative services - core buildup and prefabricated post and core up to 1 per tooth every 5 years. 30% coinsurance for bridges-pontic up to 1 every 5 years. 30% 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. 30% coinsurance per tooth for root canal, simple or surgical extraction up to 1 per lifetime. 30% coinsurance for necessary nitrous oxide/analgesia with covered service up to 1 unit(s) per visit. 30% coinsurance for scaling for moderate inflammation up to 1 per year. 30% coinsurance for emergency treatment for pain, necessary general anesthesia with covered service up to 2 per year. 30% coinsurance for necessary incremental anesthesia with covered service up to as needed with covered codes per year. $1,000 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. 30% coinsurance for amalgam and/or composite filling up to 1 per tooth per surface every 2 years. 30% coinsurance for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. 30% coinsurance for occlusal adjustment up to 1 every 3 years. 30% coinsurance for crown-porcelain fused to high noble metal, crown-porcelain fused to noble metal, crown-porcelain/ceramic, other restorative services - core buildup and prefabricated post and core up to 1 per tooth every 5 years. 30% coinsurance for bridges-pontic up to 1 every 5 years. 30% 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. 30% coinsurance per tooth for root canal, simple or surgical extraction up to 1 per lifetime. 30% coinsurance for necessary nitrous oxide/analgesia with covered service up to 1 unit(s) per visit. 30% coinsurance for scaling for moderate inflammation up to 1 per year. 30% coinsurance for emergency treatment for pain, necessary general anesthesia with covered service up to 2 per year. 30% coinsurance for necessary incremental anesthesia with covered service up to as needed with covered codes per year. $1,000 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, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | Out-of-Network: Eye Exams Services: Copayment for Medicare Covered Eye Exams $0 Coinsurance for Medicare Covered Eye Exams 35% Copayment for Medicare Covered Eyewear $0 $0 Diab Eye Exam - All POTs$35 Vision Svcs (MC) - SPC |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $35 Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $575 to $750
|
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | Out-of-Network: Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0 |
When reviewing Arkansas and Oklahoma Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Arkansas and Oklahoma that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
Arkansas Counties Served
- Arkansas
- Ashley
- Baxter
- Benton
- Boone
- Bradley
- Calhoun
- Carroll
- Chicot
- Clark
- Cleburne
- Cleveland
- Columbia
- Conway
- Craighead
- Crawford
- Crittenden
- Dallas
- Desha
- Faulkner
- Franklin
- Fulton
- Garland
- Grant
- Greene
- Hempstead
- Hot Spring
- Izard
- Jefferson
- Johnson
- Lawrence
- Le Flore
- Lee
- Lincoln
- Little River
- Logan
- Lonoke
- Madison
- Marion
- Mccurtain
- Miller
- Mississippi
- Monroe
- Montgomery
- Nevada
- Newton
- Ouachita
- Perry
- Phillips
- Pike
- Poinsett
- Polk
- Pope
- Prairie
- Pulaski
- Randolph
- Saint Francis
- Saline
- Scott
- Searcy
- Sebastian
- Sevier
- Stone
- Union
- Van Buren
- Washington
- Yell
Oklahoma Counties Served
- Adair
- Bryan
- Caddo
- Canadian
- Cherokee
- Cleveland
- Coal
- Comanche
- Craig
- Creek
- Delaware
- Garfield
- Garvin
- Grady
- Hughes
- Johnston
- Kay
- Kingfisher
- Le Flore
- Lincoln
- Logan
- Mayes
- Mcclain
- Mcintosh
- Murray
- Muskogee
- Noble
- Okfuskee
- Oklahoma
- Okmulgee
- Osage
- Ottawa
- Pawnee
- Payne
- Pittsburg
- Pontotoc
- Pottawatomie
- Rogers
- Sebastian
- Seminole
- Sequoyah
- Stephens
- Tulsa
- Wagoner
- Washington
We offer plans from Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, HealthspringSM or Kaiser Permanente.