A non-government entity
Humana Community (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Community (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Community (HMO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Humana Community (HMO) is a HMO plan offered by Humana Health Plan, Inc. available for the 2026 plan year to people living in Fayette County. CMS star rating not available for 2026.
It's important to know that Humana Community (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 Community (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 Community (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 $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
Health deductible: information not available.
This plan has a $150.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4050.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4050.00 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) prescription drug plan features an annual drug deductible of $150. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for one-month and three-month supplies at standard pharmacies or through preferred mail order. Standard mail order for these generic tiers requires a copay of $10 to $20 for a one-month supply. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply, while a three-month supply costs $131 through preferred mail order and $141 at standard pharmacies. Tier 4 non-preferred drugs require a 50% coinsurance for both one-month and three-month supplies. Specialty tier drugs under Tier 5 require a 31% coinsurance for a one-month supply across all available pharmacy and mail order channels.
Additional Benefits
The Humana Community (HMO) plan offers comprehensive coverage with no copay and no coinsurance for many everyday health needs, including primary care visits, preventive services, home health care, and routine dental, vision, and hearing exams. Members can also access up to 100 one-way transportation trips to approved locations with no copay. Specialist visits, physical therapy, and urgent care services are highly accessible with affordable copayments and no coinsurance. For emergency care and hospital stays, the plan provides financial predictability with set copayments, such as a waived-on-admission emergency room copay and no coinsurance. Skilled nursing facility care and outpatient surgeries also rely on flat copays rather than coinsurance. For specialized treatments, members should expect a 10 to 20 percent coinsurance for dialysis, durable medical equipment, and Part B medications.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Community (HMO) with no coinsurance, requiring prior authorization for both acute and psychiatric care. Acute stays require a $400 copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $400 copay for days 1 to 5 and no copay for days 6 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Community (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a $0 to $400 copay, observation services have a $400 copay per stay, and outpatient substance abuse sessions carry a $30 to $35 copay, with prior authorization required.
Partial Hospitalization See details
The Humana Community (HMO) plan covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Humana Community (HMO) plan, requiring a $335 copay and no coinsurance for ground and air ambulance services. Transportation is partially covered with no copay and no coinsurance for up to 100 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under Humana Community (HMO) are covered with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Community (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and therapy services feature copays ranging from $20 to $35 with no coinsurance. Chiropractic care is partially covered, offering routine care for a $15 copay and no coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Humana Community (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training with no copay and no coinsurance. While a memory fitness benefit is covered with no copay and no coinsurance, other additional services such as health education, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
Humana Community (HMO) hearing services are covered with no coinsurance, featuring a $30 copay for Medicare-covered exams and no copay for routine annual exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with copays ranging from $99 to $399 for up to two aids per year, excluding inner ear, outer ear, and over-the-ear types which are not covered.
Vision Services See details
Humana Community (HMO) vision services are partially covered with no coinsurance and copays ranging from no copay to $30, requiring prior authorization for exams and eyewear. One routine eye exam and one pair of eyeglasses or contact lenses are covered annually with no copay up to a $550 maximum, while other eye exams, individual lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Community (HMO) dental services are partially covered, featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services up to a $5,000 annual limit. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered by the plan.
Home Infusion bundled Services See details
Humana Community (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Medicare Part B chemotherapy, radiation, and other drugs have 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 by the Humana Community (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Community (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, requiring prior authorization. Diabetic supplies from specified manufacturers are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Community (HMO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance for diagnostic services alongside no copay for lab services and a copay of up to $105 for diagnostic procedures. Radiological services range from no copay for X-rays and diagnostic radiology to a minimum $30 copay and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by the Humana Community (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Community (HMO) covers some Cardiac Rehabilitation Services with no coinsurance and a $10 copay, though prior authorization is required. However, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Community (HMO) with no coinsurance, requiring a $10 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, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Humana Community (HMO) covers acupuncture with a $30 copay and no coinsurance for up to 20 treatments per year, which requires prior authorization. The plan also includes over-the-counter item reimbursements and meal benefits for chronic illnesses with no copay and no coinsurance, though prior authorization is required for the meal benefit.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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