A non-government entity
Humana Community (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Community (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Community (HMO-POS) in 2026, please refer to our full plan details page.
Humana Community (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Southwest Missouri. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Community (HMO-POS) 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-POS).
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-POS), 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 $3.00. 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 $615.00 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 $2500.00 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-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. If you choose standard mail order, Tier 1 drugs carry a $10 to $30 copay, and Tier 2 drugs require a $20 to $60 copay. Tier 3 preferred brand drugs cost a $47 copay for a 1-month supply, while a 3-month supply costs $141 at standard locations or a reduced $131 through preferred mail order. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Community (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care, specialist visits, preventive services, and home health care. For inpatient hospital stays, members pay a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. Emergency room visits carry a $150 copay, which is waived if admitted, while urgently needed care requires a $65 copay. Supplemental benefits are a major highlight, offering routine hearing and dental services with no copay and no coinsurance, including a generous $3,000 annual maximum for covered dental care. Vision benefits provide a routine eye exam and a $100 annual eyewear allowance with no copay or coinsurance. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance, while acupuncture and over-the-counter items require no copay.
Inpatient Hospital See details
Humana Community (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Community (HMO-POS) with no coinsurance, featuring copays ranging from $0 to $300 for hospital services and a $150 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse sessions carry a $0 to $35 copay with no coinsurance.
Partial Hospitalization See details
Humana Community (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Community (HMO-POS) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, with prior authorization required for all ambulance services. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Community (HMO-POS) 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 are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for a $150 copay and no coinsurance.
Primary Care See details
Humana Community (HMO-POS) provides primary care, specialist, mental health, and psychiatric services with no copay and no coinsurance, while physical and occupational therapy require a $15 copay and no coinsurance. Telehealth benefits have a $0 to $65 copay and opioid treatment ranges from a $0 to $35 copay, both with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Humana Community (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, diabetes self-management, and glaucoma screenings. Additional supplemental benefits are only partially covered, offering a memory fitness benefit but excluding services such as health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Humana Community (HMO-POS) hearing services include Medicare-covered and routine hearing exams, plus OTC hearing aids, all with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $299 to $599 for up to two aids yearly, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Community (HMO-POS) provides partially covered vision services with no copay, no coinsurance, and no deductible, though prior authorization is required. The plan covers one routine eye exam and up to $100 annually for one pair of contact lenses or eyeglasses (lenses and frames) per year, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Community (HMO-POS) with no copay and no coinsurance up to a maximum annual benefit of $3,000. While many preventive, restorative, and surgical care options are included, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Community (HMO-POS) covers Home Infusion bundled Services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Humana Community (HMO-POS) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Humana Community (HMO-POS), featuring a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Covered diabetic supplies carry a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Humana Community (HMO-POS) plan with no coinsurance, although prior authorization is required. Members pay no copay for lab services and outpatient X-rays, while diagnostic procedures range from a $0 to $90 copay, and radiological services feature copays starting at $0 for diagnostic and $15 for therapeutic services.
Home Health Services See details
Humana Community (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Community (HMO-POS) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. Some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Community (HMO-POS) with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, as additional days beyond the Medicare-covered limit are not covered. Prior authorization is required for these services, though a prior three-day inpatient hospital stay is not.
Other Services See details
Other services covered by Humana Community (HMO-POS) include acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits, all with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and some miscellaneous other services are not covered.
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