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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 2025, 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 2025 to people living in Select Counties in Southwest Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $5.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2600.00 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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you may pay no copay for preferred generic drugs at a standard pharmacy or $20.00 copay for the same drug at a standard mail pharmacy. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs. If you qualify for the low-income subsidy, you may have reduced costs.
Additional Benefits
The Humana Community (HMO-POS) plan offers a wide range of benefits with varying cost-sharing options. You'll find no copays for many services, including primary care, preventive services, eye exams, and dental services, as well as home health services and acupuncture. However, some services like inpatient hospital stays, outpatient services, ambulance, and emergency services have copays, and some services have coinsurance. The plan also includes coverage for hearing aids, with a copay for prescription hearing aids and coverage for over-the-counter hearing aids, as well as coverage for vision services, including eye exams and eyewear. Additionally, this plan covers home infusion services, medical equipment, and skilled nursing facility stays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $200 copay for days 1-5, and no copay for days 6-90, with additional days 91-999 covered with no copay; Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $200 copay for days 1-5, and no copay for days 6-90; Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $300, observation services with a $200 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a copay between $0 and $15 for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Community (HMO-POS) plan, but prior authorization is required. You will have a $15 copay 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. 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 Community (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $65 copay; all of these services have no coinsurance.
Primary Care See details
The Humana Community (HMO-POS) plan covers Primary Care services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25-$35 copay, Physician Specialist Services with no copay, and Mental Health Specialty Services with no copay for both individual and group sessions. The plan also covers Physical Therapy and Speech-Language Pathology Services with a $25-$35 copay, Additional Telehealth Benefits with a $0-$65 copay, and Opioid Treatment Program Services with a $0-$15 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, additional preventive services, and kidney disease education services with no copay. Other covered services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. However, some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, 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.
Hearing Services See details
Hearing services are covered, including hearing exams with no copay. Routine hearing exams are covered once per year with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with a copay between $299 and $599 for prescription hearing aids (all types), but other types of prescription hearing aids are not covered, and OTC hearing aids are covered up to $250 every three months.
Vision Services See details
The Humana Community (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, but the plan has a combined maximum of $100 for eyewear every year, and eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include no copay for Medicare dental services, 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. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Community (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Humana Community (HMO-POS), including Durable Medical Equipment with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with varying cost-sharing depending on the specific supply. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay ranging from $0 to $90, and lab services with no copay. Diagnostic Radiological Services have a maximum copay of $350, and Therapeutic Radiological Services have a copay of $15 or more. Outpatient X-Ray Services are covered with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Community (HMO-POS) 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 specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Humana Community (HMO-POS) plan, with a copay of $20 for days 1-20 and $203 for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has no copay, and the plan covers up to 20 treatments per year. OTC items are covered up to $250 every three months, and the meal benefit has no copay. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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.
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