Whether or not your doctor will accept your Humana Medicare plan depends on what Medicare plan you have and if your doctor is in your plan network.
Humana offers three different types of Medicare plans: Medicare Advantage plans, Medicare stand-alone prescription drug plans and Medicare Supplement Insurance plans.
Each type of plan has different network rules.
If you are enrolled in a Humana Medicare Advantage plan, your network will depend on the type of plan you have, such as a HMO, a PPO or a PFFS. Each plan has different rules about which medical providers and facilities you can use and what the plan will cover.1
If you have the Humana Gold Plus® HMO plan, you must choose an in-network primary care doctor. If you visit a doctor outside of your plan’s network, you may be responsible for paying some or all of your medical costs. You should ask your doctor if they are in your plan’s network before receiving any treatment or you may be responsible for paying some or all of your medical costs.
If you have the HumanaChoice® PPO plan, you can visit any Medicare-approved doctor who accepts Humana’s plan terms and agrees to bill the plan. You should ask your doctor if they accept the plan terms before receiving any treatment or you may be responsible for paying some or all of your medical costs. You typically pay less out-of-pocket if you visit an in-network provider.
If you have the Humana Gold Choice® PFFS plan, you can visit almost any Medicare-approved doctor who accepts Humana’s plan terms and agrees to bill the plan. You should ask your doctor if they accept the plan terms before receiving any treatment or you may be responsible for paying some or all of your medical costs.
Medicare stand-alone prescription drug plans only provide prescription drug coverage. Your costs may depend on the pharmacy you use.
Depending on the Humana prescription drug plan you choose, your copayments and coinsurance may be less expensive if you fill them at certain network pharmacies.2 If you are unsure if your pharmacy is a preferred cost-sharing pharmacy, you should call and ask your insurance provider before you fill your prescriptions.
Medicare Supplement Insurance plans (also called Medigap) work with Original Medicare and can help cover some of the out-of-pocket costs not covered by Medicare Part A and Part B, such as Medicare copayments, coinsurance and deductibles.3
Medicare Supplement Insurance plan availability can vary by state.
If you need help finding a Humana Medicare plan that accepts your current doctor, you can call a licensed insurance agent4 directly atTTY Users: 711 24 hours a day, 7 days a week. You can also request a free plan quote online to compare your options, with no obligation to enroll in a plan.
1Humana. Learn more about Humana Medicare Advantage plans. Retrieved from https://www.humana.com/medicare/products/medicare-advantage.
2Humana. Humana prescription drug plans (PDP). Retrieved from https://www.humana.com/medicare/products/drug-plan.
3Humana. Medicare Supplement Insurance plans. Retrieved from https://www.humana.com/medicare/products/supplement.
4TZ Insurance Solutions LLC/TruBridge licensed agents who may call you are not direct employees of Humana and are not connected with or endorsed by the U.S. Government or the federal Medicare program.
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TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.
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Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or member cost-share may change on January 1 of each year.
The pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Out-of-network/non-contracted providers are under no obligation to treat Humana members, except in emergency situations. For a decision about whether Humana will cover an out-of-network service, we encourage you or your provider to ask Humana for a pre-service organization determination before you receive the service. Please call Humana’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.
The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click here.
Last Updated 5/31/2018