Humana Medicare

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Humana Medicare Advantage Plans

The Truth About Humana Medicare Advantage: Costs and Coverage Guide

Looking to understand Medicare and Humana options for your healthcare? You’re not alone. Approximately 6 million people have enrolled in Humana Medicare Advantage plans, all seeking the best healthcare coverage.

Humana stands as the nation’s second-largest Medicare Advantage insurer, offering plans that deserve a closer look. Medicare Advantage now covers more than half of all federal insurance scheme members, yet many people find these plans difficult to understand. The plans come with an estimated average premium of $17 in 2025 and cap out-of-pocket expenses at $9,350. These numbers matter when you’re picking the right plan.

This piece breaks down everything about Humana Medicare Advantage plans. We’ll explore coverage options, costs, enrollment timing, and how to select a plan that meets your healthcare needs. New to Medicare or considering a switch? We’ve packed this guide with clear, fact-based information to help you make informed choices.

Understanding Humana Medicare Advantage Plans

Seniors looking for better healthcare coverage are turning to Medicare Advantage plans more than ever. Let’s examine these plans and see how Humana offers them to millions of Americans.

What is Medicare Advantage (Part C)?

Medicare Advantage, also called “Part C,” gives you an alternative to Original Medicare through private insurance companies that Medicare approves ^[1]. These plans consolidate all your Medicare benefits into a single package that covers everything in Part A (hospital insurance) and Part B (medical insurance) ^[1].

Medicare Advantage stands out from Original Medicare because most plans include prescription drug coverage (Part D) and additional benefits that Original Medicare doesn’t cover ^[1]. You can get:

Routine dental care (exams, X-rays, cleanings)
Vision care (eye exams, eyeglasses, contacts)
Hearing care (tests and hearing aids)
Fitness programs and gym memberships
Over-the-counter drugs ^[2]

Medicare pays these private companies a fixed monthly amount to run these plans ^[1]. While these companies follow Medicare’s rules, they can set their out-of-pocket costs and rules regarding the delivery of services ^[1].

How Humana fits into the Medicare landscape

Humana is a major player in the Medicare Advantage market, with approximately 6 million members as of 2024 ^[3]. This Kentucky-based health insurance company has grown into one of the biggest names in Medicare Advantage ^[3].

Humana’s plans reach people in many states across the country. You’ll find their plans mostly in Alabama, Florida, Georgia, Texas, and many other states. They’re known for offering various plan options that cater to different healthcare needs and budgets.

Additionally, Medicare rates Humana’s Medicare Advantage plans on an annual basis. They use a 5-star rating system [4] to help you compare the quality of different providers.

Overview of Humana MA plan options

Humana has four main types of Medicare Advantage plans:

HMO (Health Maintenance Organization) plans offer low premiums and provide additional benefits. You’ll need to use providers in the plan’s network and get referrals from your primary care doctor to see specialists ^[5]^[3].

PPO (Preferred Provider Organization) plans let you see doctors outside the network at a higher cost. These plans come with similar extras as HMOs but might cost more each month. You won’t need referrals to see specialists ^[5]^[3].

PFFS (Private Fee-for-Service) plans decide what they’ll pay healthcare providers and what you’ll pay for care. You pay providers directly based on your plan’s rates. Ensure your doctor is aware of the plan, as they may accept payment on a case-by-case basis ^[5]^[3].

SNP (Special Needs Plans) work best for specific groups, like people with chronic conditions or those in nursing homes. These plans must cover prescription drugs and often have very low or no costs for people who qualify ^[5]^[3].

Humana recently rolled out new plans with different cost structures, including monthly premiums, copays, and deductibles – each with yearly limits on what you’ll pay out of pocket ^[3].

Types of Humana Medicare Advantage Plans

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Humana offers several Medicare Advantage plan types that cater to various healthcare needs and priorities. You need to understand how these plans differ to select coverage that works best for your situation.

HMO: Health Maintenance Organization

Humana’s HMO plans, including the popular Humana Gold Plus, offer lower monthly premiums and copays compared to other plan types ^[6]. These plans need you to pick a primary care physician (PCP) from Humana’s network to coordinate your care ^[6].

The biggest challenge with HMOs is staying within the plan’s provider network for care and services, except during emergencies ^[7]. Your PCP gives referrals to see specialists, which creates a coordinated healthcare approach ^[8].

HMO plans let you visit your PCP without limits, and you can pick a new PCP anytime you want ^[6]. Similar to other Medicare Advantage plans, HMOs encompass Medicare Parts A and B benefits, and most include prescription drug coverage ^[9].

PPO: Preferred Provider Organization

Humana’s PPO plans allow you to see any Medicare-approved doctor, providing flexibility—whether they’re in or out of the provider network ^[10]. You’ll pay less by using in-network providers ^[10].

PPO plans don’t need referrals to see specialists ^[1]. This freedom means you’ll pay higher monthly premiums ^[10].

Every Humana PPO plan includes an annual maximum out-of-pocket cost limit to protect your finances once you reach that threshold ^[10].

PFFS: Private Fee-for-Service

Humana’s PFFS plans offer a unique opportunity to access Medicare coverage differently. Humana—not Medicare—decides what they pay healthcare providers and your care costs ^[1].

PFFS plans give you flexibility—you can visit almost any Medicare-approved provider who accepts the plan’s payment terms and conditions ^[11]. You won’t need referrals if providers agree to receive your plan ^[11].

Your Humana member ID card helps providers verify they still accept your plan’s terms ^[11]. Most PFFS plans cover prescriptions and emergencies anywhere in or outside the U.S. ^[11].

SNP: Special Needs Plans

Special Needs Plans help specific groups with particular healthcare needs. Humana offers three main types:

Chronic Condition SNPs (C-SNPs) – These help people with qualifying conditions like diabetes, cardiovascular disorders, chronic heart failure, or COPD ^[12]^[3].
Dual-Eligible SNPs (D-SNPs) combine Medicare and Medicaid benefits into a single, manageable plan for eligible individuals ^[12]^[3].
Institutional SNPs (I-SNPs) – These serve members in skilled nursing facilities with specialized care ^[3].

SNPs include prescription drug coverage and specialized care coordination services for their target groups ^[13].

New plan offerings in 2026

Humana will expand its Medicare Advantage footprint to 793 individual plans nationwide in 2026 ^[3]. MA plans will be available in 48 states, plus Washington, D.C., and Puerto Rico, reaching 89% of U.S. counties ^[3].

New offerings include:

Humana Full Access PPO plans will reach 20 states, letting you see any Medicare-accepting doctor at the same copay ^[3]
$0.00 LPPO MAPD Giveback plans will cover 35 states with prescription coverage and reduced Part B premiums ^[3]
Special Needs Plans will grow with D-SNPs in North Dakota and C-SNPs in Arizona, Minnesota, and New Mexico ^[3]
I-SNP expansions will reach seven new states: Iowa, Kentucky, Louisiana, New Mexico, Tennessee, Washington, and West Virginia ^[3]

Humana will also add Medicare HMO offerings in 12 new counties and Medicare Advantage LPPO plans in 17 new counties ^[3].

What’s Covered Under Humana MA Plans

Humana Medicare Advantage plans stand out from Original Medicare due to their comprehensive coverage options. You’ll get more value from your benefits by knowing what your Humana MA plan covers.

Hospital and medical services (Part A & B)

Humana Medicare Advantage plans provide coverage that is at least as comprehensive as Original Medicare Parts A and B. Your Part A coverage includes inpatient hospital stays, skilled nursing facility care, hospice care, and certain home health care services. Part B covers doctor visits, outpatient care, preventive services, and medically necessary services.

Humana MA plans deliver extra value by offering additional benefits beyond Original Medicare. They usually come with predictable copayments instead of Original Medicare’s 20% coinsurance.

Prescription drug coverage (Part D)

Most Humana Medicare Advantage plans come with prescription drug coverage, so that you won’t need a separate Part D plan. These plans typically give you:

Coverage for both brand-name and generic medications
Access to network pharmacies, including mail-order options
Tiered pricing structures that help lower costs

Humana’s prescription coverage extends to thousands of medications, but coverage differs by plan. Be sure to review Humana’s drug formulary (a list of covered medications) before enrolling.

Dental, vision, and hearing benefits

Seniors love Humana MA plans because they cover services that Original Medicare doesn’t. Many Humana plans offer:

Routine dental exams, cleanings, and X-rays
Eyeglasses or contacts following cataract surgery
Simple hearing tests and discounts on hearing aids

Benefits vary substantially between different Humana plans in states like Florida, Texas, and Nevada.

Fitness programs and wellness perks

Wellness benefits have become a highlight of Humana MA plans. Many plans offer the SilverSneakers fitness program with access to thousands of fitness locations nationwide. Members also get:

Nurse advice lines are available 24/7
Health coaching programs
Annual wellness visits at no extra cost

Emergency coverage while traveling

Humana MA plans typically cover emergencies when you travel within the United States, even if you are outside your plan’s service area. Some plans even cover international travel emergencies, though limits apply to coverage duration and maximum benefits.

Members in border states, such as Arizona, New Mexico, and Texas, should be familiar with their travel coverage, as they frequently cross state lines.

Costs You Should Know About

James O’Neal Founder, Owner, CEO visionary leader. Helping clients and Medicare beneficiaries in over 30 States better understand how their individual health and ACA insurance, dental, vision, hearing, critical illness coverage cancer, stroke, heart attack, End-Stage Renal Disease (ESRD), original Aetna, Humana, Devoted Health, Blue Cross Blue Shield of Illinois Medicare advantage plans, supplement Part D prescription drug coverage & options.

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The actual cost of Humana Medicare Advantage plans goes well beyond the monthly premium you see advertised. Let me break down what you’ll pay with these plans.

Monthly premiums and how they vary

Humana Medicare Advantage plans will cost around $17 per month on average in 2025 ^[14]. All but one of these plans (49%) come with a $0 monthly premium ^[4]. The costs stay the same from January 1 throughout the year ^[14]. Your location and plan type affect these premiums, especially in states like Florida, Texas, or Nevada.

Deductibles, copays, and coinsurance

The Medicare Part A deductible reaches $1,676 per benefit period ^[15] in 2025, while Part B costs $257 annually ^[15]. After meeting your deductible, you pay:

Copayments: Set amounts like $20 for covered services
Coinsurance: Usually 20% of covered costs

Medicare Part D plans cannot charge more than $590 in 2025 ^[15] as a deductible.

Out-of-pocket maximums (MOOP)

Humana MA plans offer better financial protection than Original Medicare through maximum out-of-pocket limits. The 2025 MOOP limit stands at $9,350 ^[8], though Humana often sets lower caps. Your plan covers 100% of eligible services after you hit this limit ^[14].

Part B premium and how Humana handles it

Medicare Advantage members must pay their Part B premium ($185.20 in 2025) ^[16]. Your income might increase this amount through an Income Related Monthly Adjustment Amount (IRMAA) ^[16]. Humana’s Giveback plans help offset some Part B premium costs ^[4].

Extra costs for out-of-network care

Humana PPO members pay more when they see providers outside their network ^[10]. The plan won’t cover charges above its maximum allowable fee. These additional expenses usually don’t count toward your out-of-pocket maximum ^[17]. Network providers help you save money substantially.

Enrollment, Eligibility, and Switching Plans

The Medicare enrollment process can feel overwhelming, but understanding when and how to sign up for Humana Medicare Advantage plans is significant to get the coverage you need.

Original Enrollment Period (IEP)

Your Medicare experience starts with your Initial Enrollment Period. This period spans a 7-month window that begins 3 months before your 65th birthday month, continues through your birthday month, and extends 3 months after ^[2]. You can enroll in Original Medicare (Parts A and B) and then choose a Humana Medicare Advantage plan during this time.

Medicare Parts A and B enrollment occurs automatically for individuals who receive Social Security benefits for at least 4 months before turning 65 [2]. All others need to sign up actively. Your coverage start date depends on the timing of your enrollment during the IEP. The coverage begins the month you turn 65 if you sign up before your birthday month ^[2].

Annual Enrollment Period (AEP)

The Medicare Annual Enrollment Period runs from October 15 through December 7 each year ^[18]. You can make these changes during this time:

Switch from Original Medicare to a Humana Medicare Advantage plan
Change from one Medicare Advantage plan to another
Return to Original Medicare from a Medicare Advantage plan
Add or drop prescription drug coverage

Changes made during AEP become effective on January 1 of the following year ^[18].

Special Enrollment Periods (SEPs)

Some life changes qualify you for Special Enrollment Periods outside standard enrollment windows. These qualifying events include:

Moving to a new address outside your plan’s service area
Losing an employer or COBRA health coverage
Gaining or losing Medicaid eligibility
Moving into or out of a skilled nursing facility ^[19]

Your SEP length varies based on the qualifying event and typically lasts between 2 and 3 months ^[20].

How to switch or drop a Humana plan

The Medicare Advantage Open Enrollment Period (January 1-March 31) or AEP allows you to switch your Humana plan ^[21]. You can make one change during this period, such as switching to a different Medicare Advantage plan or reverting to Original Medicare ^[22].

To disenroll, you must submit a written request or complete an online disenrollment form. Phone requests aren’t accepted for disenrollment ^[5]. Note that late enrollment penalties may apply if you drop prescription drug coverage without getting other creditable coverage ^[5].

Using www.humana.com Medicare tools

Humana’s online resources help simplify your Medicare experience. Their website has tools to:

Compare available plans in your area
Check drug coverage and costs
Find network providers
Complete enrollment applications

You can call 1-800-472-2986 (TTY: 711) for personalized assistance, available 24/7 ^[23].

Conclusion

Making Your Medicare Decision

Your unique healthcare needs should guide your selection of a Medicare Advantage plan. This piece examines Humana, the second-largest Medicare Advantage provider, which serves approximately 6 million people nationwide.

Humana offers a variety of plan options. Their HMOs come with lower premiums and network restrictions, while PPOs cost more but offer greater flexibility. Special Needs Plans assist individuals with specific health conditions, while PFFS plans establish customized payment arrangements. Additionally, most plans include prescription drug coverage, as well as dental, vision, and hearing benefits – benefits that Original Medicare doesn’t cover.

Financial considerations play a significant role in selecting any Medicare plan. Humana’s plans in 2025 average $17 monthly, which won’t break the bank. Better yet, almost half their plans don’t charge any premium at all. However, you’ll need to consider deductibles, copays, and the $9,350 maximum out-of-pocket limit to get the complete financial picture.

Timing is a crucial aspect of obtaining the proper coverage. You can enroll during your original Enrollment Period around your 65th birthday, the Annual Enrollment Period from October 15 to December 7, or Special Enrollment Periods that life events trigger. Getting these dates right helps you avoid gaps in coverage and extra fees.

Humana’s online tools allow you to compare plans in your area before making a decision. Their plans are available to 89% of U.S. counties, covering 48 states, Washington, D.C., and Puerto Rico, including Alabama, Florida, Georgia, Texas, Nevada, and many others.

Some of the cities and states we help Medicare beneficiaries in are Alabama, Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Nevada, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington DC, Wisconsin, Henderson, Las Vegas South, North Las Vegas, Southwest Las Vegas, and Summerlin Nevada.

Medicare Advantage plans now cover more than half of all Medicare beneficiaries. However, your best choice ultimately depends on your specific healthcare needs, budget, and preferred doctors. Healthcare isn’t one-size-fits-all. The right Medicare Advantage plan should give you detailed coverage at a price you can afford, plus access to care whenever and wherever you need it.

FAQs

Q1. What are the main types of Humana Medicare Advantage plans? Humana offers four main types of Medicare Advantage plans: HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), PFFS (Private Fee-for-Service), and SNP (Special Needs Plans). Each type has distinct features to cater to different healthcare needs and preferences.

Q2. How much do Humana Medicare Advantage plans typically cost? The average monthly premium for Humana Medicare Advantage plans in 2025 is projected to be around $17. However, about half of Humana’s plans have a $0 monthly premium. Costs can vary based on location and plan type, and you should also consider deductibles, copays, and out-of-pocket maximums.

Q3. What additional benefits do Humana Medicare Advantage plans offer? Most Humana Medicare Advantage plans include prescription drug coverage, as well as dental, vision, and hearing benefits, along with fitness programs like SilverSneakers. Many plans also offer wellness perks such as 24/7 nurse advice lines and health coaching programs.

Q4. When can I enroll in a Humana Medicare Advantage plan? You can enroll during your Initial Enrollment Period (around your 65th birthday), the Annual Enrollment Period (October 15 – December 7), or during Special Enrollment Periods triggered by certain life events. The Medicare Advantage Open Enrollment Period (January 1 – March 31) also allows for plan changes.

Q5. How does Humana Medicare Advantage compare to Original Medicare? Humana Medicare Advantage plans typically offer more comprehensive coverage than Original Medicare. They include everything covered by Medicare Parts A and B, often add prescription drug coverage, and provide additional benefits not covered by Original Medicare, such as dental, vision, and hearing care. However, they may have network restrictions and different cost structures.

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