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.
Humana Community (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Joaquin. This plan received an overall rating of 3 out of 5 stars in 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
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) Medicare plan offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $615.00. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generic drugs cost an $8.00 copay at standard pharmacies, while Tier 3 preferred brands require a 50% coinsurance. These cost-sharing rates apply until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug expenses reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy Extra Help program will benefit from no premium for their Part D coverage. This plan provides structured prescription drug costs to help you effectively manage your healthcare budget.
Additional Benefits
The Humana Community (HMO) plan offers affordable healthcare coverage featuring no copay for primary care, specialist, and routine preventive visits. For hospital care, members pay a $50 daily copay for the first five days of inpatient stays and no copay for outpatient ambulatory surgical services. Emergency room visits require a $150 copay, which is waived upon admission, while urgent care is available for a $65 copay. In addition to core medical care, the plan provides dental, vision, and hearing benefits, including up to $3,000 annually for dental services and a $300 yearly allowance for eyewear with no copays. Routine hearing exams and over-the-counter hearing aids also feature no copay, while durable medical equipment and dialysis services are covered with coinsurance ranging from 10% to 20% and no copay. These combined benefits help minimize out-of-pocket costs for your essential daily healthcare needs.
Inpatient Hospital See details
Humana Community (HMO) partially covers inpatient hospital services with no coinsurance, featuring a $50 daily copay for days 1 through 5 (and no copay for days 6 through 999) for acute care, and a $900 copay per stay for psychiatric admissions. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Community (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a $0 to $50 copay, observation services have a $50 copay per stay, and outpatient substance abuse sessions carry a $25 to $35 copay.
Partial Hospitalization See details
Humana Community (HMO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Community (HMO), offering ground ambulance for a $335 copay and air ambulance for a $630 copay, both with no coinsurance and requiring prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Community (HMO) 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 are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all available for a $150 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Humana Community (HMO), as podiatry services and routine chiropractic care are not covered. Covered services feature no coinsurance, with copays ranging from no copay for primary care, specialist, and therapy visits up to $65 for telehealth and specialty services.
Preventive Services See details
Humana Community (HMO) covers preventive services—including annual physicals, kidney disease education, and memory fitness—with no copay and no coinsurance. However, the benefit is only partially covered, as the plan excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Humana Community (HMO) covers hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499 to $799 for general types, while inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Humana Community (HMO) partially covers Vision Services with no copay, no coinsurance, and no deductible, including one routine eye exam and up to $300 annually for contact lenses or eyeglasses. However, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Community (HMO) partially covers dental services up to a $3,000 annual limit, featuring no copay and no coinsurance for most covered services, while fixed and removable prosthodontics require a 30% coinsurance and no copay. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Community (HMO) covers home infusion bundled services, requiring prior authorization and featuring a $35 copay alongside coinsurance ranging from no coinsurance to 20% for Medicare Part B insulin. Other covered Part B drugs, including chemotherapy and radiation, have no copay and require coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Community (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive coverage for these services.
Medical Equipment See details
Medical equipment is covered by Humana Community (HMO), featuring a 15% coinsurance and no copay for durable medical equipment (DME) and medical supplies, and a 20% coinsurance with no copay for prosthetics. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Humana Community (HMO) covers diagnostic and radiological services with prior authorization and a doctor referral. Members pay no copay or coinsurance for lab services and outpatient X-rays, a $0 to $65 copay with no coinsurance for diagnostic procedures, a $0 to $300 copay with no coinsurance for diagnostic radiological services, and a 20% coinsurance with no copay for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by Humana Community (HMO) with no copay and no coinsurance. To access this benefit, a doctor referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Community (HMO) plan. In practice, none of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered by this plan.
Skilled Nursing Facility (SNF) See details
Humana Community (HMO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond Medicare-covered days are not covered. Covered stays require prior authorization and a doctor referral, featuring no coinsurance and a copay of $20 per day for days 1 to 20 and $218 per day for days 21 to 100.
Other Services See details
Humana Community (HMO) partially covers other services, offering acupuncture, over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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