Humana Community (HMO)

Inpatient Hospital See details

Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $440 copay for days 1-6, and no copay for days 7-90, and for Inpatient Hospital Psychiatric, you will pay a $440 copay for days 1-5, and no copay for days 6-90.

Outpatient Services See details

Outpatient Services, including all outpatient hospital services, are covered under the Humana Community (HMO) plan. Outpatient hospital services have a copay between $0 and $440, observation services have a $440 copay, and ambulatory surgical center services have no copay.

Outpatient substance abuse services have a copay between $45 and $80 for both individual and group sessions, and outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered with a $55 copay, and prior authorization is required.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $315 copay, while transportation services to a plan-approved health-related location have no copay and are limited to 48 one-way trips per year via taxi, bus/subway, or medical transport. 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) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $125 copay, while Urgently Needed Services have a $55 copay, and there is no coinsurance for any of these services.

Primary Care See details

The Humana Community (HMO) plan covers primary care physician services and chiropractic services with no copay, and occupational therapy services with a copay between $20 and $30. The plan also covers physician specialist services with a $30 copay, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a copay between $20 and $30, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services.

Preventive Services See details

The Humana Community (HMO) plan covers a variety of preventive services. Annual physical exams have no copay, while additional preventive services like fitness benefits, glaucoma screening, diabetes self-management training, and more have no copay. Some services, like health education and home-based palliative care, are not covered.

Hearing Services See details

Hearing services include coverage for 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, with a copay between $99 and $399 for all types of hearing aids, but not for inner ear, outer ear, or over the ear aids. OTC hearing aids are covered with a maximum benefit of $100 every three months.

Vision Services See details

Vision services include eye exams and eyewear. Eye exams have a copay of $0-$30, and routine eye exams have no copay. Eyewear has no copay, with a combined maximum plan benefit of $250 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.

Dental Services See details

Dental services include Medicare dental services with a $30 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery, all with no copay; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum of $3,000 per year for other dental services.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the Humana Community (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Humana Community (HMO) plan. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered by the Humana Community (HMO) plan. Diagnostic Procedures/Tests have a copay ranging from $0 to $105, while Lab Services have no copay. Diagnostic Radiological Services have a copay that is at most $720, and Therapeutic Radiological Services have a copay of at most $30 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.

Home Health Services See details

Home Health Services are covered by Humana Community (HMO) with no copay and no coinsurance. However, 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 any specific services. Prior authorization is required.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) benefits are covered by the Humana Community (HMO) plan, but require prior authorization. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.

Other Services See details

The Humana Community (HMO) plan covers acupuncture with a $30 copay, and covers over-the-counter items, including nicotine replacement therapy and Naloxone, with a maximum benefit of $100 every three months. The plan also covers a meal benefit with no copay. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.