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 2025 to people living in Select Counties in Southwest Missouri. This plan received an overall rating of 3.5 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) Medicare plan has an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generic drugs, there is no copay for 1-month or 3-month supplies filled at standard pharmacies or through preferred mail order. If you choose standard mail order, Tier 1 drugs have a $10 copay for a 1-month supply and Tier 2 drugs have a $20 copay. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail order services, though a 3-month preferred mail order supply is discounted at $131. Tier 4 non-preferred drugs are subject to a 50% coinsurance for both 1-month and 3-month supplies. Lastly, Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply across all available pharmacy and mail order channels.
Additional Benefits
The Humana Community (HMO-POS) plan offers comprehensive medical coverage with no copays or coinsurance for primary care, specialist visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $150 for the first five days and no copay for days six through ninety. Outpatient services feature no coinsurance, with copays ranging from no copay for ambulatory surgical centers up to $300 for outpatient hospital services. This plan also includes valuable dental, vision, and hearing benefits, featuring no copays or coinsurance for routine cleanings, exams, and hearing aid fittings, alongside a $3,000 annual maximum for covered dental services. Vision care includes a routine annual exam with no copay and a $100 annual allowance for glasses or contact lenses. Additionally, members can access acupuncture, over-the-counter items, and meal benefits for chronic illnesses with no copays or coinsurance.
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 to 5 and no copay for days 6 to 90. While unlimited additional acute hospital 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-POS) outpatient services are covered with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay of $0 to $300 (with a $150 copay per stay for observation services), while outpatient substance abuse individual and group sessions carry a copay of $0 to $35.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Community (HMO-POS) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Community (HMO-POS) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Humana Community (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Community (HMO-POS) primary care benefits offer primary care, specialist, mental health, psychiatric, and other health professional services with no copay and no coinsurance. Physical, occupational, and speech therapy require a $15 copay and no coinsurance, telehealth and opioid services have copays ranging up to $65 and $35 respectively with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services under Humana Community (HMO-POS) are covered with no copay and no coinsurance for annual physicals, kidney disease education, diabetes self-management, and glaucoma screenings. This benefit is only partially covered because while a memory fitness program is included, sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, weight management, alternative therapies, and home-based palliative care are not covered.
Hearing Services See details
Hearing services are covered by Humana Community (HMO-POS), featuring no copay or coinsurance for routine hearing exams, fitting evaluations, and over-the-counter hearing aids. Prescription hearing aids are partially covered with no coinsurance and a copay of $299.00 to $599.00 for up to two devices per year, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Humana Community (HMO-POS) partially covers vision services with no copay, no coinsurance, and no deductible, though prior authorization is required. The plan covers one routine eye exam per year and provides a $100 annual limit for one pair of contact lenses or eyeglasses (lenses and frames), while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Community (HMO-POS) offers partially covered dental services with no copay and no coinsurance, up to a maximum annual benefit of $3,000. While preventive and comprehensive services like cleanings, exams, and fillings are covered, fluoride treatments, implants, orthodontics, and maxillofacial prosthetics 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 and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Community (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Humana Community (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Covered diabetic supplies have a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Community (HMO-POS) with no coinsurance, although prior authorization is required. Lab services and outpatient X-rays feature no copay, while diagnostic procedures and tests range from a $0 to $90 copay, and therapeutic radiological services have a minimum copay of $15.
Home Health Services See details
Humana Community (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Community (HMO-POS) covers some cardiac rehabilitation services with no copay or coinsurance and prior authorization required, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Community (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required for admission, and additional days beyond the Medicare-covered limit are not covered.
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 available with no copay and no coinsurance. Prior authorization is required for acupuncture, which is limited to 20 treatments per year, and the meal benefit, while certain other miscellaneous services are not covered.
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