What Humana is and the plans it offers

Humana is a private health insurance company that sells plans to individuals, families, and employers. It operates in most U.S. states and offers several types of coverage: Medicare Advantage plans (for people 65 and older), Medicaid plans (for lower-income individuals and families), individual and family plans sold through the health insurance marketplace, and employer group plans.

The type of Humana plan available to you depends on your age, income, and employment status. Someone turning 65 would look at Medicare Advantage options. A self-employed person might browse marketplace plans. An employee at a company with a Humana group contract would enroll through their employer. Each plan type has different costs, coverage rules, and networks of doctors and hospitals.

Humana does not run government programs — it is a private company contracted to deliver benefits under Medicare and Medicaid. When you enroll in a Humana plan, you are buying insurance from Humana itself, not from a government agency.

Key Takeaways

  • Humana offers Medicare Advantage, Medicaid, marketplace, and employer plans, each with different may be able to access rules and costs.
  • Each Humana plan has a network of in-network doctors and hospitals; using out-of-network providers usually costs you more.
  • Costs vary by plan type and location — a Medicare Advantage plan in one state may differ from the same plan type in another.
  • You can enroll in a Humana plan during specific periods: Medicare Advantage during the annual enrollment period, marketplace plans during open enrollment, Medicaid year-round in most states, and employer plans when hired or during your company's open enrollment.
  • Humana's customer service phone number and online portal let you check coverage details, find in-network providers, and manage your account.

How Humana Medicare Advantage plans work

Humana Medicare Advantage plans are an alternative to Original Medicare (the government program). If you are 65 or older and enrolled in Medicare Part A and Part B, you can switch to a Humana Medicare Advantage plan during the annual enrollment period, which runs from October 15 to December 7 each year.

Medicare Advantage plans bundle hospital, doctor, and prescription drug coverage into one plan. You pay a monthly premium to Humana (in addition to your Medicare Part B premium), and you use only doctors and hospitals in Humana's network unless it is an emergency. Most Humana Medicare Advantage plans include dental, vision, and hearing coverage — benefits Original Medicare does not cover. However, you typically pay a copay or coinsurance when you see a doctor or fill a prescription, and you may face an annual out-of-pocket maximum.

The specific benefits, costs, and network vary by plan and location. Two Humana Medicare Advantage plans in the same state may have different premiums, deductibles, and covered services. You can compare plans on Medicare.gov during the enrollment period.

Humana Medicaid plans and who they serve

Humana administers Medicaid plans in several states. Medicaid is a joint federal and state program for people with low income. Each state runs its own Medicaid program and contracts with private insurers like Humana to deliver coverage.

If you are enrolled in your state's Medicaid program and Humana is one of the plan options available to you, you can choose a Humana plan during your state's enrollment period. In most states, you can enroll in Medicaid year-round, though some states have specific enrollment windows. Medicaid covers doctor visits, hospital care, prescription drugs, and preventive services, often with little or no cost to you at the point of care.

Humana Medicaid plans vary by state because each state designs its own Medicaid program. A Humana Medicaid plan in Florida covers different services and has a different network than a Humana Medicaid plan in California. Contact your state's Medicaid office or Humana directly to learn what is available where you live.

Marketplace plans and how to enroll

Humana sells individual and family health plans through the federal health insurance marketplace (Healthcare.gov) and some state marketplaces. These plans are for people who do not have coverage through an employer, Medicare, or Medicaid.

Open enrollment for marketplace plans runs from November 1 to January 15 each year. During this period, you can browse Humana plans on Healthcare.gov, compare costs and coverage, and enroll. Outside open enrollment, you can enroll only if you experience a may have access to life event — such as losing employer coverage, getting married, having a child, or moving to a new state.

Humana marketplace plans come in four metal levels: Bronze, Silver, Gold, and Platinum. Bronze plans have the lowest monthly premium but higher out-of-pocket costs when you use care. Platinum plans have the highest premium but lower costs per visit. If your income falls below certain thresholds, you may be able to receive a tax credit or cost-sharing reduction that lowers your premium or out-of-pocket costs.

Employer group plans through Humana

Some employers contract with Humana to provide health insurance to their employees. If your employer offers a Humana plan, you typically enroll during your company's open enrollment period, which is usually once per year. New hires often have a window to enroll within 30 days of their start date.

Humana employer plans vary widely depending on what your company negotiates. Your premium, deductible, copays, and covered services depend on your specific plan. Your employer may cover part or all of your premium, and you pay the rest through payroll deduction.

To learn what Humana plans your employer offers, check your company's benefits materials or contact your human resources or benefits department.

In-network providers and how to find them

Every Humana plan has a network of doctors, hospitals, and other providers that have agreed to work with Humana at set rates. When you use an in-network provider, you pay your plan's copay or coinsurance. When you use an out-of-network provider, you typically pay a higher percentage of the cost, and the provider may bill you for the difference between what they charge and what Humana pays.

To find in-network providers, log into your Humana account online or call Humana's customer service number (on the back of your insurance card). You can search by provider name, specialty, or location. Before scheduling an appointment, confirm the provider is in-network and that your plan covers the service you need.

Networks vary by plan and location. A doctor in-network for one Humana plan may not be in-network for another Humana plan in the same area. Always verify before you go.

Costs: premiums, deductibles, and out-of-pocket limits

Humana plan costs have four main parts: the monthly premium (what you pay to Humana), the deductible (what you pay out of pocket before insurance starts to pay), copays or coinsurance (what you pay per visit or service), and the annual out-of-pocket maximum (the most you will pay in a year for in-network care).

These costs vary significantly by plan type and location. A Humana Medicare Advantage plan in Arizona may have a different premium and deductible than the same plan type in Texas. A Humana marketplace Silver plan in one state may cost more or less than a Silver plan in another. Employer plans vary based on what the employer negotiates.

When comparing Humana plans, look at the total cost you expect to pay in a year, not just the premium. A plan with a low premium but a high deductible may cost you more overall if you use a lot of care. Use the plan comparison tools on Healthcare.gov (for marketplace plans) or Medicare.gov (for Medicare Advantage) to estimate your costs based on your expected care.

How to contact Humana and manage your account

Humana provides customer service by phone, online portal, and mail. Your insurance card lists a customer service phone number specific to your plan type. You can also visit Humana's website to create an account, view your coverage details, find providers, request a replacement card, and submit questions.

If you need to make changes to your plan — such as updating your address, adding a family member, or reporting a change in income — contact Humana during the allowed enrollment period. Outside of enrollment periods, you can make changes only if you have a may have access to life event.

Keep your insurance card with you and bring it to every doctor visit and pharmacy. If you lose your card, you can request a replacement through your online account or by calling customer service.

Frequently Asked Questions

Can I switch from one Humana plan to another during the year?

No, unless you have a may have access to life event such as losing other coverage, moving, getting married, or having a child. Outside of these events, you can change plans only during your plan's annual enrollment period.

Does Humana cover prescriptions?

Most Humana plans include prescription drug coverage, but the drugs covered and your copay vary by plan. Check your plan documents or call Humana to see if a specific medication is covered and what you will pay.

What happens if I use an out-of-network doctor?

You will pay a higher percentage of the cost, and the doctor may bill you for the difference between their charge and what Humana pays. In emergencies, out-of-network care is usually covered at in-network rates. Always verify a provider is in-network before scheduling non-emergency care.

How do I know if I owe money after a doctor visit?

Humana sends an explanation of benefits (EOB) after each claim. The EOB shows what the provider charged, what Humana paid, and what you owe. Review it carefully. If you disagree with the amount, call Humana to ask questions.

Can I enroll in a Humana plan outside of open enrollment?

You can enroll in a Humana marketplace plan outside open enrollment only if you have a may have access to life event. Medicaid enrollment is year-round in most states. Medicare Advantage enrollment is limited to the annual enrollment period and a few other windows. Contact Humana or your state program to learn your options.