Is Humana Choice PPO a Medicare Advantage Plan? What You Need to Know

Yes, Humana Choice PPO is a Medicare Advantage plan

Humana Choice PPO is a type of Medicare Advantage plan — also called Part C — that Humana offers in certain areas. It is not Original Medicare (Part A and Part B). Instead, it is a private insurance plan that contracts with Medicare to cover your hospital and doctor visits, usually with lower premiums than Original Medicare combined with a Medigap policy.

The "PPO" part means Preferred Provider Organization. This structure lets you see doctors and specialists both inside and outside Humana's network, though you pay less when you use in-network providers. You do not need a referral to see a specialist, which is different from some other Medicare Advantage plans.

Humana Choice PPO plans vary by state and county. Not every area has the same plan options, and the costs, coverage details, and provider networks differ depending on where you live. You can only enroll in a plan that is offered in your ZIP code.

Key Takeaways

Humana Choice PPO is a Medicare Advantage plan, meaning it replaces Original Medicare and is run by a private insurer, not the government.
PPO plans let you see out-of-network doctors without a referral, but you pay more for out-of-network care than in-network care.
Availability and costs vary by location — you must check what plans Humana offers in your ZIP code during the enrollment period.
Medicare Advantage plans include prescription drug coverage (Part D) and often add dental, vision, or hearing benefits that Original Medicare does not cover.
You must have both Part A and Part B to enroll in any Medicare Advantage plan, and you cannot use Medigap coverage at the same time.

How Humana Choice PPO differs from Original Medicare

Original Medicare is a fee-for-service program run by the federal government. You can see any doctor who accepts Medicare, anywhere in the country. You pay a deductible and coinsurance for each service, and you need a separate Medigap or Part D plan for drug coverage.

Humana Choice PPO is a managed care plan. Humana contracts with a network of doctors and hospitals and agrees to provide your coverage in exchange for a monthly premium. The plan includes prescription drug coverage built in — you do not buy Part D separately. Many Humana Choice PPO plans also include dental, vision, and hearing coverage at no extra cost, which Original Medicare does not offer.

The trade-off is that your choice of providers is limited. If you see an out-of-network doctor with Humana Choice PPO, you pay more out of pocket. With Original Medicare, the provider network does not matter — you can see anyone who accepts Medicare. If you travel frequently or have strong ties to doctors outside Humana's network, Original Medicare may suit you better.

What "PPO" means and how the network works

PPO stands for Preferred Provider Organization. In a PPO plan, doctors and hospitals are divided into two groups: in-network and out-of-network. You pay the lowest costs when you use in-network providers. You can also see out-of-network providers without asking permission first — you do not need a referral — but your out-of-pocket costs will be higher.

This is different from an HMO (Health Maintenance Organization) Medicare Advantage plan, where you must use in-network doctors except in emergencies, and you need a referral to see a specialist. With Humana Choice PPO, the flexibility is built in, but so is the higher cost for going outside the network.

Before you enroll, you should check whether your current doctors are in Humana's network in your area. Humana publishes a provider directory on its website, or you can call the plan to ask. If your main doctors are not in the network, the out-of-pocket costs may be too high to make the plan worthwhile for you.

Costs and coverage details you should know

Humana Choice PPO plans have a monthly premium, an annual deductible, and copays or coinsurance for doctor visits, hospital stays, and prescriptions. The exact amounts depend on which plan you choose and where you live. Some plans have a $0 premium, but those usually have higher deductibles or copays. Others charge a monthly premium but have lower out-of-pocket costs per visit.

All Medicare Advantage plans have an out-of-pocket maximum — a yearly limit on what you pay for covered services. Once you hit that limit, the plan pays 100% of covered costs for the rest of the year. This is a safety net that Original Medicare does not have.

Prescription drugs are covered under the plan's Part D benefit. You choose a tier of drugs (generic, preferred brand, non-preferred brand, or specialty), and you pay a copay for each prescription. The coverage and copays change each year, so you should review the plan's formulary — the list of covered drugs — before you enroll, especially if you take regular medications.

How to learn about Humana Choice PPO is available where you live

Humana does not offer the same plans in every state or county. To find out what Humana Choice PPO plans are available in your area, go to Medicare.gov and use the Plan Finder tool. Enter your ZIP code, and the tool will show you all Medicare Advantage plans available to you, including which ones are from Humana and what they cost.

You can also call Humana directly at 1-800-833-2590 (TTY 711) to ask what plans they offer in your area. Have your ZIP code ready. Humana's customer service can tell you the plan names, premiums, deductibles, and whether your doctors are in the network.

Availability changes year to year. A plan you had last year may not be offered this year, or new plans may become available. You should check every year during the Annual Enrollment Period (October 15 to December 7) to see what your options are.

When you can enroll and what happens if you miss the important date

You can enroll in a Medicare Advantage plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Coverage starts on January 1 of the following year. You can also enroll when you first become may be able to access for Medicare — usually at age 65 — or if you experience a may have access to life event like losing employer coverage.

If you miss the Annual Enrollment Period and do not have a may have access to event, you cannot enroll in a Medicare Advantage plan until the next October. This is why it is important to mark the enrollment dates on your calendar and review your options each year, even if you are happy with your current plan.

If you are already in a Medicare Advantage plan and want to switch to a different one — or to Original Medicare — you can do so during the Annual Enrollment Period. You can also switch plans during the Medicare Advantage Open Enrollment Period (January 1 to March 31) if you are already enrolled in a Medicare Advantage plan.

Important rules about Medicare Advantage and Medigap

If you enroll in Humana Choice PPO, you cannot also have a Medigap policy. Medicare does not allow you to use both at the same time. Medigap is designed to fill the gaps in Original Medicare, so it does not work with Medicare Advantage plans, which already include their own cost-sharing structure.

If you currently have a Medigap policy and want to switch to Humana Choice PPO, you will need to drop the Medigap coverage first. If you later decide to leave the Medicare Advantage plan and go back to Original Medicare, you may have trouble getting a Medigap policy again, depending on your state's rules and how long you have been in the Medicare Advantage plan. Some states protect your right to buy Medigap, but others do not.

Before you switch from Original Medicare to a Medicare Advantage plan, think carefully about whether you might want to go back. If you do switch and later regret it, you may face higher Medigap premiums or denial of coverage for pre-existing conditions, depending on your state.

Frequently Asked Questions

Can I use Humana Choice PPO if I live outside the service area part of the year?

Medicare Advantage plans are tied to a specific service area. If you spend part of the year in another state or county where Humana does not serve, you may have trouble getting care covered. Some plans offer out-of-area coverage for emergencies, but routine care outside the service area is usually not covered. If you travel frequently or split time between two homes, ask Humana about their out-of-area policy before you enroll.

Do I need to choose a primary care doctor with Humana Choice PPO?

Most Humana Choice PPO plans do not require you to choose a primary care doctor, though some do. Check your specific plan's rules. Even if a primary care doctor is not required, having one can help coordinate your care and may lower your costs for specialist visits.

What happens to my coverage if Humana leaves my area?

If Humana stops offering a plan in your area, Medicare will notify you and give you time to switch to a different plan. You will have a special enrollment period to change plans without waiting for the Annual Enrollment Period. Medicare will help you find alternative coverage.

Can I switch from Humana Choice PPO to Original Medicare anytime I want?

You can switch during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to event. Outside those windows, you cannot switch unless you meet specific criteria. If you switch back to Original Medicare, you may lose the right to buy certain Medigap policies depending on your state, so plan ahead.

Does Humana Choice PPO cover dental and vision?

Many Humana Choice PPO plans include dental and vision coverage, but not all. The coverage varies by plan and location. Some plans offer routine cleanings and eye exams; others cover more extensive work like crowns or glasses. Check your specific plan's benefits before you enroll.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.