What Humana Covers Under Medicare: Hospital, Doctor, and Prescription Drug Plans

Humana's Medicare coverage depends on which plan you choose

Humana offers three main types of Medicare plans: Original Medicare supplement plans (Medigap), Medicare Advantage plans (Part C), and prescription drug plans (Part D). Each covers different services and costs you different amounts out of pocket. The coverage you get is not the same across all three — a Medigap plan covers different things than a Medicare Advantage plan, even though both come from Humana.

To know what Humana covers for you specifically, you need to know which plan type you have or are considering. Your plan documents or your Humana member ID card will tell you which one. If you are unsure, you can call Humana's customer service number on your card, or look at your plan's summary of coverage on Humana's website.

Key Takeaways

Humana Medigap plans cover some or all of the costs that Original Medicare does not pay, such as copayments, coinsurance, and deductibles.
Humana Medicare Advantage plans replace Original Medicare and typically include prescription drug coverage, but limit you to Humana's network of doctors and hospitals.
Humana Part D plans cover prescription medications and are separate from hospital and doctor coverage — you must have Original Medicare or a Medicare Advantage plan to use one.
Coverage varies by specific plan, state, and year, so your plan documents are the only source that shows what you personally pay and what is covered.

Humana Medigap plans cover gaps in Original Medicare

Humana Medigap (supplement) plans are designed to pay for costs that Original Medicare leaves you responsible for. Original Medicare covers hospital stays (Part A) and doctor visits (Part B), but you pay a deductible, copayments, and coinsurance. A Medigap plan fills in some or all of those gaps, depending on which lettered plan (A through N) you choose.

For example, a Humana Medigap Plan G covers your Part B deductible, coinsurance for hospital stays and doctor visits, and some costs for skilled nursing facilities. A Humana Medigap Plan N covers similar items but charges you a copayment for some doctor visits and emergency room visits. The exact coverage for each letter plan is set by Medicare, so a Plan G from Humana covers the same things as a Plan G from any other company — the difference is the monthly premium Humana charges.

Medigap plans do not cover prescription drugs. If you need drug coverage, you must sign up for a separate Humana Part D plan or get it through another company.

Humana Medicare Advantage plans bundle hospital, doctor, and drug coverage

Humana Medicare Advantage (Part C) plans combine hospital coverage, doctor coverage, and usually prescription drug coverage into one plan. Instead of using Original Medicare, you use Humana's network of doctors, hospitals, and pharmacies. You typically pay a monthly premium, a deductible, and copayments or coinsurance when you use services.

Most Humana Medicare Advantage plans include dental, vision, and hearing coverage that Original Medicare does not offer. Some plans also include fitness benefits or transportation to medical appointments. However, these extra benefits vary by plan and by state — not every Humana Medicare Advantage plan in your area offers the same extras.

The main trade-off is that you must use doctors and hospitals in Humana's network. If you see an out-of-network provider without a referral, you may pay more or the visit may not be covered at all. Some Humana Medicare Advantage plans allow out-of-network emergency care, but you should check your plan documents to know for certain.

Humana Part D plans cover prescription medications

Humana Part D plans cover prescription drugs at participating pharmacies. These plans are separate from hospital and doctor coverage — you can only use a Part D plan if you also have Original Medicare or a Medicare Advantage plan. Part D plans have a monthly premium, an annual deductible, and copayments or coinsurance for each prescription.

Humana Part D plans use a formulary, which is a list of medications the plan covers. Not every drug is on the formulary, and drugs on the formulary may be in different tiers — a Tier 1 generic drug costs less than a Tier 3 brand-name drug. If your doctor prescribes a drug that is not on the formulary, you can ask Humana for an exception, but there is no may provide it will be approved.

Part D coverage has a coverage gap (sometimes called the "donut hole") where you pay a higher share of drug costs after you and the plan have spent a certain amount. Once your out-of-pocket costs reach a yearly limit, catastrophic coverage kicks in and you pay a small copayment for the rest of the year.

What is not covered by any Humana Medicare plan

Medicare and Humana plans do not cover routine dental work, routine eye exams, eyeglasses, or hearing aids — though some Humana Medicare Advantage plans offer limited dental and vision benefits as an extra. Original Medicare and Medigap plans do not cover these services at all.

Long-term care, custodial care, and most services outside the United States are not covered. Experimental treatments and some elective surgeries are also not covered unless your doctor gets prior approval from Humana. Routine foot care, weight loss programs, and cosmetic surgery are not covered.

How to find your specific coverage details

Your Humana plan documents include a Summary of Coverage and a detailed Evidence of Coverage (EOC) document. The Summary of Coverage is shorter and shows what you pay and what is covered for common services. The EOC is longer and includes rules, limits, and exceptions. Both documents are sent to you when you enroll and are available on Humana's website or by calling the number on your member ID card.

You can also use the Medicare Plan Finder tool on Medicare.gov to compare Humana plans in your area and see what each plan covers. This tool shows you the monthly premium, deductible, and copayments for doctor visits, hospital stays, and common prescriptions. It does not show every detail, but it is a good starting point if you are comparing plans.

If you have questions about whether a specific service or drug is covered, call the customer service number on your Humana member ID card. Have your member ID ready and be specific about the service or drug you are asking about — for example, "Does my plan cover a colonoscopy with no copayment?" rather than "What preventive care do you cover?"

Coverage changes every year

Humana's plans, premiums, and coverage change every year on January 1. A plan you had last year may have a different premium, different copayments, or different drugs on the formulary this year. During the annual enrollment period (October 15 to December 7), you can switch to a different Humana plan or switch to a plan from another company.

Humana will send you a notice in the fall showing your plan's changes for the coming year. Read this notice carefully, especially if your medications or doctors are changing. If your plan no longer covers a drug you take or your doctor is leaving the network, you may want to switch plans during open enrollment.

Frequently Asked Questions

Does Humana Medicare cover preventive care with no copayment?

Original Medicare and most Humana plans cover certain preventive services (like annual wellness visits, cancer screenings, and vaccines) with no copayment or coinsurance. However, coverage varies by plan type and specific service. Check your plan documents or call Humana to confirm which preventive services your plan covers with no cost to you.

Can I use my Humana Medicare plan outside my home state?

Humana Medicare Advantage plans are usually limited to a specific service area within your state. If you travel or move, you may not be able to use your plan outside that area. Humana Medigap plans work with any doctor or hospital that accepts Original Medicare, so you can use them anywhere in the country. Check your plan documents for details on out-of-area coverage.

What happens if Humana does not cover a service my doctor recommends?

You can ask Humana for a coverage information or exception. Your doctor can submit a request explaining why the service is medically necessary. Humana will review the request and tell you whether it approves coverage. If Humana denies the request, you have the right to appeal. You can also contact Medicare's Independent Review Entity if you disagree with Humana's decision.

Do I need a referral to see a specialist with Humana Medicare Advantage?

Most Humana Medicare Advantage plans require a referral from your primary care doctor to see a specialist. Some plans allow you to see certain specialists without a referral. Check your plan documents or call Humana to find out whether your plan requires referrals and which specialists are exempt.

How do I know if my pharmacy is in Humana's network?

Humana publishes a pharmacy directory on its website and in your plan documents. You can search by pharmacy name or location. You can also call the pharmacy directly and ask whether they accept your Humana plan. Using an out-of-network pharmacy may cost you more or may not be covered at all.

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.