A non-government entity
Humana FMOL Lafayette H1951-054 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana FMOL Lafayette H1951-054 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana FMOL Lafayette H1951-054 (HMO) in 2025, please refer to our full plan details page.
Humana FMOL Lafayette H1951-054 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Lafayette. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana FMOL Lafayette H1951-054 (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 FMOL Lafayette H1951-054 (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 FMOL Lafayette H1951-054 (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 $24.00. 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 $500.00 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 $3700.00 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 FMOL Lafayette H1951-054 (HMO) plan has a $500 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, in the initial coverage phase, you will pay $10 for preferred generic drugs at a preferred pharmacy. You will pay 47% coinsurance for preferred brand drugs at a standard pharmacy. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana FMOL Lafayette H1951-054 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays that vary. Preventive services, routine eye exams, and many dental services are available with no copay, while other services like hearing exams, specialist visits, and therapy services have copays. The plan covers ambulance services and emergency services with copays. Diagnostic tests, lab services, and home health services have no copay. The plan also includes coverage for hearing aids, vision eyewear, and over-the-counter items.
Inpatient Hospital See details
Inpatient hospital benefits are covered, with a $115 copay for days 1-10 and no copay for days 11-90. Additional days for inpatient hospital-acute have no copay for days 91-999. Inpatient Hospital Psychiatric benefits are covered, with a $115 copay for days 1-10 and no copay for days 11-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $200, observation services with a $115 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $20 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana FMOL Lafayette H1951-054 (HMO) plan, with a $20 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance; however, Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana FMOL Lafayette H1951-054 (HMO) plan. Emergency Services has a $140 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
The Humana FMOL Lafayette H1951-054 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $20 copay. Physician specialist services have a $30 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $20 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a copay between $0 and $35. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, while additional preventive services like Additional Sessions of Smoking and Tobacco Cessation Counseling and Fitness Benefit have a copay. Other services, like Health Education, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, and OTC hearing aids are covered up to $75 every three months.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $30, and routine eye exams have no copay, and eyewear has no copay, with a combined maximum benefit of $300 every year.
Dental Services See details
The Humana FMOL Lafayette H1951-054 (HMO) plan covers a variety of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $1,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana FMOL Lafayette H1951-054 (HMO) plan, with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies (non-Medicare benefit) with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a coinsurance of 10-20% and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
For Humana FMOL Lafayette H1951-054 (HMO), diagnostic and radiological services are covered. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a copay between $20 and $30, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana FMOL Lafayette H1951-054 (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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana FMOL Lafayette H1951-054 (HMO) plan, but require prior authorization. For days 1-20, there is a $20 copay, and for days 21-100, the copay is $214; there is no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana FMOL Lafayette H1951-054 (HMO) plan covers acupuncture with a $30 copay, and up to 20 treatments per year, and also covers over-the-counter items with a $75 maximum benefit every three months. The plan offers a meal benefit with no copay.
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