A non-government entity
UC San Diego Health Humana (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UC San Diego Health Humana (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UC San Diego Health Humana (HMO) in 2025, please refer to our full plan details page.
UC San Diego Health Humana (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Diego County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that UC San Diego Health Humana (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 UC San Diego Health Humana (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 UC San Diego Health Humana (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 $6.00. 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 $950.00 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 UC San Diego Health Humana (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy or through mail order, but you'll pay a $20 copay for standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. This plan may also have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The UC San Diego Health Humana (HMO) plan offers a wide range of benefits, including inpatient hospital stays with a $100 copay, outpatient services with varying copays, and coverage for ambulance services with a copay or coinsurance. You'll also find coverage for primary care, preventive, vision, and dental services, often with no copay. Additional benefits include hearing services with no copay for exams and routine care, and prescription hearing aids with a copay. The plan also covers home health services, medical equipment, and diagnostic services, with copays or coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $100 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $50, Observation Services with a $100 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $0 and $25 for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
The UC San Diego Health Humana (HMO) plan covers ambulance services, but requires prior authorization. Ground ambulance services have a $195 copay, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UC San Diego Health Humana (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $80 copay, while Urgently Needed Services has no copay.
Primary Care See details
The UC San Diego Health Humana (HMO) plan offers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services have no copay. Occupational therapy services, mental health specialty services, psychiatric services, additional telehealth benefits, and opioid treatment program services have a copay ranging from $0 to $25. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, kidney disease education services, and other preventive services, with a copay that varies by service. Some services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, while routine hearing exams and fitting/evaluation for hearing aids also have no copay. Prescription hearing aids have a copay between $199 and $499 per year.
Vision Services See details
The UC San Diego Health Humana (HMO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The UC San Diego Health Humana (HMO) plan covers dental services with 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, and Oral and Maxillofacial Surgery; however, Prosthodontics, removable and Prosthodontics, fixed services have a 30% coinsurance. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the UC San Diego Health Humana (HMO) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, with a 9% coinsurance for Durable Medical Equipment. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10% coinsurance with no copay. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, lab services, and radiological services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of at most $50 and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the UC San Diego Health Humana (HMO) plan 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 specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $100 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the UC San Diego Health Humana (HMO) plan, acupuncture and meal benefits are covered with no copay, and acupuncture requires prior authorization, while over-the-counter items, 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, 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 are not covered. Acupuncture is limited to 20 treatments per year.
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