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 2026 to people living in Lake, Marion, and Sumter counties. This plan received an overall rating of 4.5 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 $2.00. 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 $175.00 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 $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:
Sign up for Humana Community (HMO)
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Drug Coverage
The Humana Community (HMO) prescription drug plan features an annual drug deductible of $175. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a standard pharmacy or preferred mail order. Standard mail order for these generic tiers requires a copay of $10 for Tier 1 and $20 for Tier 2 for a one-month supply. Tier 3 preferred brand drugs have a $30 copay for a one-month supply at standard pharmacies and preferred mail order, or $47 through standard mail order. Tier 4 non-preferred drugs require a 37% coinsurance across all fulfillment methods. Specialty drugs in Tier 5 carry a 31% coinsurance for a one-month supply at standard pharmacies, preferred mail, and standard mail.
Additional Benefits
The Humana Community (HMO) plan offers affordable healthcare coverage with no copay for primary care physician visits, annual physical exams, and routine preventive screenings. For inpatient hospital stays, members pay no coinsurance and a $150 daily copay for the first six days, with no copay for days seven through 90. Specialist visits, urgent care, and outpatient services generally require low copays ranging from $20 to $25, while emergency room visits carry a $150 copay that is waived if you are admitted. This plan also features robust additional benefits, including comprehensive vision and dental coverage with an annual dental maximum of $4,000 and no copay for most services. Vision benefits include a $400 yearly allowance for eyewear with no copay, and routine hearing exams and up to two over-the-counter hearing aids are also covered with no copay. Additionally, members benefit from no copay on home health services, acupuncture, and over-the-counter items, though specialty services like dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Humana Community (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $150 daily copay for days 1 through 6 and no copay for days 7 through 90 per stay. While unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Community (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which feature no copays. Outpatient hospital services have a copay of $0 to $155 (or $150 per stay for observation), and outpatient substance abuse sessions have a copay of $20 to $25.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Community (HMO) plan with a $35.00 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), with ground ambulance services requiring a $0 to $240 copay and coinsurance, and air ambulance services requiring a 20% coinsurance and a copay. Prior authorization is required for all ambulance services, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Humana Community (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are covered with a $150 copay per service and no coinsurance.
Primary Care See details
Humana Community (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and therapy services have a $20 to $25 copay and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, excluding routine and other chiropractic services which are not covered.
Preventive Services See details
Preventive services are partially covered under the Humana Community (HMO) plan, featuring no copays and no coinsurance for annual physical exams, kidney disease education, and routine screenings. While memory fitness and in-home support are covered with no copays and no coinsurance, several additional services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Humana Community (HMO) with no deductible, featuring a $20 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams, fittings, and up to two OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,500 maximum per ear annually, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Community (HMO) covers vision services with no copays, coinsurance, or deductibles, including one annual routine eye exam and a $400 yearly limit for contact lenses or eyeglasses. This benefit is partially covered, as other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Community (HMO) offers partially covered dental services with an annual maximum of $4,000, featuring no copay and no coinsurance for most services, except for Medicare dental which has a $20 copay and no coinsurance, and prosthodontics which has no copay and 30% coinsurance. 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. Associated Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Humana Community (HMO) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these services.
Medical Equipment See details
Humana Community (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with a 20% coinsurance and no copay for most items. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Community (HMO) covers diagnostic and radiological services with prior authorization and referrals required. Diagnostic tests and procedures have no coinsurance and a copay ranging from $0 to $50, while lab services, diagnostic radiology, and outpatient X-rays have no copay. Therapeutic radiological services require a minimum 20% coinsurance and a minimum $10 copay.
Home Health Services See details
Humana Community (HMO) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Humana Community (HMO) with no coinsurance, but only some services are covered as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These services require prior authorization and a referral, with a $10 copay for cardiac and intensive cardiac rehabilitation, and a $20 copay for pulmonary rehabilitation and SET for PAD.
Skilled Nursing Facility (SNF) See details
Humana Community (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $160 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under the Humana Community (HMO) are partially covered, featuring acupuncture, over-the-counter items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while sub-services categorized as Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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