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 2026, 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 out of 5 stars in 2026.
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 $1.00. 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 a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4350.00 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:
Sign up for Humana Community (HMO)
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Drug Coverage
The Humana Community (HMO) prescription drug plan features a $150 drug deductible. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. If you use standard mail order, Tier 1 drugs have a $10 copay and Tier 2 drugs have a $20 copay for a one-month supply. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, though a three-month supply through preferred mail order lowers your cost to $131. For higher-tier medications, Tier 4 non-preferred drugs have a 50% coinsurance, while Tier 5 specialty drugs require a 31% coinsurance for a one-month supply.
Additional Benefits
The Humana Community (HMO) plan offers robust medical coverage with no copay for primary care visits and a $35 copay for specialist appointments. For hospital needs, inpatient stays require a $350 daily copay for the first five days and no copay thereafter, while outpatient hospital services feature copays ranging from no copay up to $325. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care is available with a $50 copay. This plan also includes valuable supplemental benefits with no deductibles and no coinsurance for routine dental, vision, and hearing care. Preventive dental services, routine eye exams, and over-the-counter hearing aids all feature no copay, though there is a $3,000 annual limit on dental and a $500 annual limit on eyewear. Additionally, members can access up to 60 plan-approved one-way transportation trips per year with no copay, while durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Community (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 5 and no copay for days 6 to 90. Prior authorization is required, and while unlimited additional acute days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Community (HMO) with no coinsurance, featuring a $0 to $325 copay for outpatient hospital services, a $350 copay per stay for observation services, and a $35 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, though prior authorization is required for most of these benefits.
Partial Hospitalization See details
Humana Community (HMO) covers partial hospitalization with a $35 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Humana Community (HMO), as transportation to any health-related location is not covered. Covered ground and air ambulance services require a $335 copay and no coinsurance, while plan-approved transportation is covered for up to 60 one-way trips per year with no copay and no coinsurance.
Emergency Services See details
Emergency services are covered by Humana Community (HMO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay per service and no coinsurance.
Primary Care See details
Humana Community (HMO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Therapy, mental health, and telehealth services are covered with copays ranging from $0 to $50 and no coinsurance, while chiropractic care is partially covered—excluding other chiropractic services—and podiatry is not covered.
Preventive Services See details
Humana Community (HMO) preventive services are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, diabetes training, and select supplemental benefits like memory fitness and chemotherapy wigs. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, in-home medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Humana Community (HMO) covers hearing services with no deductible and no coinsurance, providing routine exams, fitting evaluations, and OTC hearing aids with no copay. Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with a $99 to $699 copay and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over the ear prescription hearing aids.
Vision Services See details
Humana Community (HMO) provides partially covered vision services with no coinsurance, no deductibles, and prior authorization required. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay (with a $500 annual limit for eyewear), while other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Community (HMO) partially covers dental services up to a $3,000 annual limit, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Community (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Community (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Community (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic services, with prior authorization required for most items. DME, prosthetics, and medical supplies feature no copay and 20% coinsurance, while diabetic supplies have no copay and 10% to 20% coinsurance, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Community (HMO), requiring prior authorization. Lab services and outpatient X-rays have no copay, diagnostic tests have no coinsurance and copays up to $105, and therapeutic radiological services require a minimum 20% coinsurance and a $35 copay.
Home Health Services See details
Home Health Services are covered under the Humana Community (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Community (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Humana Community (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by Humana Community (HMO), including acupuncture with a $35 copay and no coinsurance (limited to 20 treatments per year), and both over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Dual eligible SNPs and other unspecified services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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