Humana Medicare Advantage Plans: What They Cover and What They Cost

Humana Medicare Advantage is a type of Medicare plan run by Humana, a private insurance company. It combines your hospital and doctor coverage (Parts A and B) into one plan, and usually adds prescription drug coverage too. You pay Humana a monthly premium, and they handle claims instead of Original Medicare.

Whether a Humana plan is right for you depends on your health, where you live, and how much you use doctors and hospitals. Humana offers different plan types — HMO, PPO, and PFFS — each with different rules about which doctors you can see and how much you pay when you do. The plan you can join also depends on your ZIP code, because Humana does not serve all areas equally.

The main trade-off is this: Humana Medicare Advantage plans often have lower or zero monthly premiums than Original Medicare plus a Medigap policy, but they limit which providers you can use and may charge you more per visit. Some people save money; others spend more. The only way to know is to compare what you would actually pay under each option.

Key Takeaways

  • Humana Medicare Advantage plans combine hospital, doctor, and usually drug coverage in one plan, but restrict you to Humana's network of doctors and hospitals in your area.
  • Monthly premiums are often lower than Original Medicare plus Medigap, but you pay per visit through copays and coinsurance, which can add up if you see doctors frequently.
  • You must live in a Humana service area to join, and available plans vary by ZIP code — check Humana's website or Medicare.gov to see what is offered where you live.
  • Switching to Humana locks you into their network until the next open enrollment period (October 15 to December 7 each year), so compare carefully before you enroll.
  • Humana plans include an out-of-pocket maximum, which Original Medicare does not, so your costs are capped — but you must use in-network providers to benefit from that cap.

How Humana Medicare Advantage Plans Work Differently From Original Medicare

Original Medicare is run by the federal government and pays any doctor or hospital that accepts Medicare. Humana Medicare Advantage is run by Humana and only pays doctors and hospitals in Humana's network. If you see an out-of-network provider, you pay much more — sometimes the full bill.

With Original Medicare, you pay a deductible, then Medicare pays a percentage and you pay a percentage for each service, with no upper limit on what you spend. With Humana Medicare Advantage, you pay copays or coinsurance per visit, and Humana sets an out-of-pocket maximum — once you hit it, Humana covers everything else for the rest of the year. That cap protects you from catastrophic costs, but only if you stay in network.

Humana Medicare Advantage also includes prescription drug coverage in most plans, whereas Original Medicare requires you to buy a separate Part D plan. That can simplify your paperwork, but it also means your drug coverage and medical coverage are bundled — if you switch plans, both change at once.

Premiums, Copays, and Out-of-Pocket Costs

Humana Medicare Advantage premiums vary by plan type and location. Some plans have zero monthly premium; others charge $50 to $200 or more per month. The premium is what you pay to Humana before you use any services.

When you use services, you pay copays (a fixed amount per visit) or coinsurance (a percentage of the cost). A doctor visit might cost $20 to $50; an urgent care visit might cost $75 to $150; a hospital stay might cost $250 to $500 per day. These amounts vary by plan, so you must check the specific plan's cost-sharing schedule before you enroll.

Every Humana Medicare Advantage plan has an out-of-pocket maximum — the most you will pay in copays and coinsurance in a year. Once you hit it, Humana covers the rest. The maximum varies by plan but typically ranges from $5,000 to $7,000 per year. This is a real protection: Original Medicare has no maximum, so your costs can keep rising.

However, this maximum only applies to in-network care. If you use an out-of-network provider, those costs may not count toward the maximum, and you may owe the full bill.

Network Restrictions and Finding Doctors

Humana Medicare Advantage plans are built around a network — a list of doctors, hospitals, and other providers that have agreed to work with Humana. You must use in-network providers to get the copay prices and have Humana cover most of the cost. Out-of-network providers charge you much more or may not be covered at all.

Before you enroll in a Humana plan, check whether your current doctors are in the network. Humana's website has a provider search tool where you can enter your doctor's name or specialty and your ZIP code. If your doctor is not in the network, you have two choices: switch doctors, or choose a different plan.

Network size varies by plan and location. In urban areas, Humana networks are usually large. In rural areas, networks may be small, and you may have fewer choices. Some Humana plans are HMOs, which require you to pick a primary care doctor who coordinates your care; others are PPOs, which let you see specialists without a referral.

Who Should and Should Not Choose Humana Medicare Advantage

Humana Medicare Advantage works well for people who see doctors regularly but want predictable costs. The out-of-pocket maximum means you know the worst-case scenario, and the included drug coverage simplifies your bills. If you are healthy and rarely see doctors, the low or zero premium is attractive.

Humana Medicare Advantage is a poor fit if you travel frequently or live part of the year in another state, because you must use in-network providers and networks change by location. It is also risky if you have a doctor you must see and that doctor is not in Humana's network, or if you live in a rural area with few in-network options.

If you have complex health needs or see many specialists, check the plan's referral rules and specialist copays before enrolling. Some Humana plans charge $50 or more per specialist visit, which adds up quickly. Original Medicare plus Medigap may cost less in that situation, even though the premium is higher.

How to Compare Humana Plans to Other Options

The only honest way to compare is to add up what you would actually pay under each option. Start by listing the doctors and hospitals you use most often. Then check three things: whether they are in the Humana network, what the copays are, and how often you see them.

Next, multiply the copay by the number of visits you expect in a year. Add the monthly premium times 12. Add any out-of-pocket costs for prescriptions. That is your total expected cost under Humana.

Then do the same calculation for Original Medicare plus a Medigap plan and a Part D drug plan. Compare the totals. The cheaper option depends entirely on your health and your doctors — there is no universal answer.

You can also use the Medicare Plan Finder tool on Medicare.gov. Enter your doctors, hospitals, and prescriptions, and it will show you the estimated costs for each plan available in your area. This tool is free and does not require you to enroll.

When You Can Switch Plans and What Happens If You Change Your Mind

You can join a Humana Medicare Advantage plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Coverage starts January 1. You can also join during the Initial Enrollment Period when you first become may be able to access for Medicare, or if you have a may have access to life event like moving to a new state or losing employer coverage.

Once you enroll, you are locked into the plan until the next Annual Enrollment Period. If you change your mind after January 1, you cannot switch to a different plan until October 15, unless you have a may have access to event. This is why comparing carefully before you enroll matters.

If you switch back to Original Medicare after being on Humana, you have a limited time to enroll in a Medigap plan without medical underwriting. If you wait too long, the insurance company can deny you or charge you more based on your health. Check the rules before you switch.

Frequently Asked Questions

Can I use any doctor I want with Humana Medicare Advantage?

No. You must use doctors and hospitals in Humana's network to get the copay prices and have Humana cover most of the cost. Out-of-network providers may charge you the full bill. Some Humana plans are HMOs, which also require you to use a primary care doctor who refers you to specialists.

What happens if I move to a state where Humana does not have a network?

If you move outside Humana's service area, you can switch to a different Medicare plan without waiting for open enrollment. This is a may have access to event. You have 60 days from the date you move to enroll in a new plan. Contact Medicare or Humana to start the process.

Does Humana Medicare Advantage cover prescription drugs?

Most Humana Medicare Advantage plans include prescription drug coverage, but the drugs covered and the copays vary by plan. Check the plan's formulary — the list of covered drugs — before you enroll to make sure your medications are included. Some drugs require prior approval from Humana before the pharmacy will fill them.

Is Humana Medicare Advantage cheaper than Original Medicare?

It depends on your health and your doctors. Humana plans often have lower premiums, but you pay per visit through copays. If you see doctors frequently, those copays add up. If you are healthy and rarely see doctors, Humana is usually cheaper. Use the Medicare Plan Finder to compare your actual costs.

What if I do not like my Humana plan after I enroll?

You cannot switch plans until the next Annual Enrollment Period (October 15 to December 7) unless you have a may have access to event like moving or losing coverage. This is why comparing before you enroll is important. If you have a may have access to event, contact Medicare to see if you can switch early.