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 Lake, Marion and Sumter counties. This plan received an overall rating of 4 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 $4.30. 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 $2400.00 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 a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, standard generic drugs have a $0 copay at a standard pharmacy, while preferred brand drugs have a 46% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan's premium may also be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Humana Community (HMO) plan offers a range of benefits with varying cost-sharing options. The plan covers inpatient and outpatient services, including hospital stays and mental health services, with copays ranging from $0 to $150. Primary care visits, preventive services, and many dental services have no copay, while hearing and vision services are also included, with copays for exams and coverage for hearing aids. Additional benefits include coverage for ambulance services, emergency care, and home health services, with a 20% coinsurance for air ambulance and no copay for home health. The plan also includes coverage for medical equipment, diagnostic services, and skilled nursing facilities, with specific copays and coinsurance for different services. Other services such as acupuncture, over-the-counter items, and a meal benefit are covered, while some services like cardiac rehabilitation and certain types of therapy require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Humana Community (HMO) plan. For Inpatient Hospital-Acute, you'll pay a $150 copay for days 1-6, and no copay for days 7-90, while for Inpatient Hospital Psychiatric, you'll also pay a $150 copay for days 1-6 and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Humana Community (HMO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $125, observation services with a $150 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered, with individual sessions having a copay between $20 and $50, and group sessions also having a copay between $20 and $50. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $25 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Community (HMO) plan. Ground ambulance services have a copay between $0 and $280, while air ambulance services have a 20% coinsurance, and transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Community (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $35 copay, and all services have no coinsurance.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, and a $20-$25 copay for Occupational Therapy Services. Also covered are Physician Specialist Services with a $20 copay, Mental Health Specialty Services with a $20 copay, and Podiatry Services with a $20 copay. Other Health Care Professional services have a copay of $0-$20, Psychiatric Services have a $20 copay, and Physical Therapy and Speech-Language Pathology Services have a $20-$25 copay. Additional Telehealth Benefits have a $0-$35 copay, and Opioid Treatment Program Services have a $20-$50 copay.
Preventive Services See details
The Humana Community (HMO) plan covers preventive services, including an annual physical exam with no copay, as well as additional preventive services, kidney disease education services, and other preventive services, all of which have a $0 copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. In-Home Support Services and Fitness Benefit are covered with no copay.
Hearing Services See details
The Humana Community (HMO) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) requiring a copay between $199 and $1299, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. Over-the-counter hearing aids are covered up to $150 every three months.
Vision Services See details
The Humana Community (HMO) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $20, and eyewear has no copay, with a combined maximum benefit of $400 per year. Contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $4,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. Restorative services, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay and 30-40% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Community (HMO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Humana Community (HMO) covers dialysis services, but requires prior authorization and a doctor's referral. The coinsurance for this service is 20%.
Medical Equipment See details
The Humana Community (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with a 20% coinsurance and authorization required, with no copay. Prosthetic devices and medical supplies are covered; prosthetic devices have a 10% coinsurance, and medical supplies have no copay. Diabetic equipment is covered with a coinsurance for Medicare-covered diabetic therapeutic shoes or inserts, and a copay for Medicare-covered diabetes supplies and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
The Humana Community (HMO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $125, and Therapeutic Radiological Services have a copay up to $20 with coinsurance of at least 20%. 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. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Community (HMO) plan. Prior authorization and a doctor's referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Community (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $190 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture with no copay, and over-the-counter items with a maximum benefit of $150 every three months. The plan also provides a meal benefit with no copay. However, 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 are not covered.
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