Humana Community (HMO) is a Medicare Advantage Plan by Humana.
This page features plan details for 2024 Humana Community (HMO) H7621 – 003 – 0 available in San Joaquin County.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
Humana Community (HMO) is offered in the following locations.
Humana Community (HMO) offers the following coverage and cost-sharing.
Insurer: | Humana |
Health Plan Deductible: | $0.00 |
MOOP: | $2,900 In-network |
Drugs Covered: | Yes |
Ready to sign up for Humana Community (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $0.00 | $ |
Humana Community (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$0.00 | $ |
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | $10.00 copay | |
2 (Generic) | $10.00 copay | $10.00 copay | $20.00 copay | |
3 (Preferred Brand) | $47.00 copay | $47.00 copay | $47.00 copay | |
4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay | $100.00 copay | |
5 (Specialty Tier) | 33% | 33% | 33% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $0.00 copay | $30.00 copay | |
2 (Generic) | $30.00 copay | $0.00 copay | $60.00 copay | |
3 (Preferred Brand) | $141.00 copay | $131.00 copay | $141.00 copay | |
4 (Non-Preferred Drug) | $300.00 copay | $290.00 copay | $300.00 copay | |
5 (Specialty Tier) |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
Humana Community (HMO) also provides the following benefits.
$0 |
In-network | No |
$2,900 In-network |
Yes |
In-network | No |
$0-100 copay per visit (Authorization is required.) (Referral is required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $0 copay (Authorization is required.) (Referral is required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $135 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $0 copay (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0-50 copay (Authorization is required.) (Referral is required.) |
Lab services | $0 copay (Authorization is required.) (Referral is required.) |
Diagnostic radiology services (e.g., MRI) | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient x-rays | $0 copay (Authorization is required.) (Referral is required.) |
Hearing exam | $0 copay (Authorization is required.) (Referral is required.) |
Fitting/evaluation | $0 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Routine eye exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
Physical therapy and speech and language therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
$250 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
Foot exams and treatment | $0 copay (Authorization is required.) (Referral is required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Diabetes supplies | $0 copay or 10% coinsurance per item (Authorization is required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
$175 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is required.) |
Inpatient hospital – psychiatric | $900 per stay (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
$0 per day for days 1 through 20 $120 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
Monthly Premium | $33.10 |
Deductible | nan |
Monthly Premium | $50.20 |
Deductible | nan |
Monthly Premium | $51.20 |
Deductible | nan |
Comprehensive dental: | Monthly Premium: | $30.10 |
Comprehensive dental: | Deductible: | N/A |
Comprehensive dental: | Monthly Premium: | $37.20 |
Comprehensive dental: | Deductible: | N/A |
Preventive dental: | Monthly Premium: | $48.40 |
Preventive dental: | Deductible: | N/A |
Comprehensive dental: | Monthly Premium: | $48.40 |
Comprehensive dental: | Deductible: | N/A |
Ready to sign up for Humana Community (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Need more information on Humana Community (HMO)? See 2025 Humana Community (HMO) at MedicareAdvantageRX.com.
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
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