A non-government entity
Humana Community (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Community (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Community (HMO) in 2025, please refer to our full plan details page.
Humana Community (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Northern Kentucky Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Humana Community (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Community (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Community (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4950.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Community (HMO) plan has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at a standard pharmacy and a $20 copay at a standard mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Community (HMO) plan offers a variety of services with varying costs. Inpatient hospital stays require a $350 copay for days 1-5, with no copay for additional days, and outpatient services have copays between $0 and $350. Emergency services have a $125 copay, while primary care and preventive services are generally available with no copay. The plan also includes coverage for hearing, vision, and dental services. Hearing exams, routine eye exams, and most dental services have no copay. The plan provides coverage for prescription hearing aids with copays between $99 and $699, eyewear with no copay up to a $200 annual benefit, and dental services with a $3,000 annual maximum benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Humana Community (HMO) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services, including individual and group sessions, have a copay between $35 and $75.
Partial Hospitalization See details
Partial Hospitalization is covered with a $50 copay, but prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $315 copay, while transportation services to a plan-approved health-related location has no copay for up to 60 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Humana Community (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Emergency Transportation have a $125 copay, while Urgently Needed Services have a $55 copay, with no coinsurance for any of these services.
Primary Care See details
The Humana Community (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $10-$40 copay, physician specialist services with a $35 copay, mental health specialty services with a $35 copay, other health care professional services with a $0-$35 copay, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $10-$40 copay, additional telehealth benefits with a $0-$55 copay, and opioid treatment program services with a $35-$75 copay. Podiatry services are not covered.
Preventive Services See details
The Humana Community (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including wigs for hair loss related to chemotherapy, are also covered. Other services like health education, in-home safety assessment, and others are not covered.
Hearing Services See details
The Humana Community (HMO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with all types covered with a copay between $99 and $699, while inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids are covered up to $75 every three months.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $35, while routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay, with a combined maximum plan benefit coverage of $200 every year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $35 copay for Medicare dental services and no copay for other services. The plan has an annual maximum benefit of $3,000. Preventive services include oral exams, dental x-rays, other diagnostic services, cleanings, and other preventive dental services, all with no copay. Fluoride treatment is not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Community (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Humana Community (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Community (HMO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $105, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $560, Therapeutic Radiological Services have a maximum copay of $35 and a minimum coinsurance of 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Community (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Community (HMO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Community (HMO) plan covers acupuncture with a $35 copay, and covers up to 20 treatments per year with prior authorization. Over-the-counter items are covered, with a maximum benefit coverage amount of $75 every three months, and meal benefits are covered with no copay and prior authorization. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, and the following other services are not covered: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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