What Does Humana Medicare Advantage Cover? Benefits, Costs, and Extras

A Humana Medicare Advantage plan covers everything Original Medicare Parts A and B cover — hospital stays, doctor visits, emergency care, and preventive services — and most plans add prescription drug coverage along with dental, vision, hearing, fitness programs, and an allowance for over-the-counter items. What any single plan pays for depends on the plan type and your ZIP code, so the picture below is what Humana typically offers across its 2026 lineup, not a promise for a specific plan.

Hospital, Doctor, and Preventive Care

Every Humana Medicare Advantage plan has to match the Original Medicare baseline for hospital and outpatient services, and most layer on an annual out-of-pocket cap that Original Medicare does not have. Cost-sharing varies. One representative PPO plan charges $440 per day for the first six days of an inpatient stay and $0 per day after that, $440 for outpatient surgery, and $340 at an ambulatory surgery center.¹

Emergency room visits on that same plan cost $130, with the copay waived if you’re admitted within 24 hours. Urgent care runs $50.¹

Most Humana plans charge $0 for primary care office visits.²¹³

All Medicare-approved preventive services are covered at $0. That includes cancer screenings (breast, cervical, colorectal, lung, and prostate), cardiovascular and diabetes screenings, diabetes self-management training, annual wellness visits, immunizations, depression screenings, glaucoma tests, HIV screenings, and smoking cessation counseling. The “Welcome to Medicare” visit for new enrollees is also free.¹

Prescription Drugs

Most Humana Medicare Advantage plans bundle Part D prescription drug coverage into the plan, and every Special Needs Plan is required to.⁴ Drug costs depend on the plan’s formulary tier. Across Humana’s 2026 plans, about 99 percent charge $0 for Tier 1 preferred generics, and roughly 38 percent charge $0 for Tier 2 generics.³

Insulin copays for Medicare Part D are capped at $35 for a 30-day supply under the Inflation Reduction Act. All 2026 Part D plans also carry a $2,100 annual out-of-pocket maximum on drugs. Once you hit it, the plan covers 100 percent of covered drugs for the rest of the year.⁵

Dental, Vision, and Hearing

Original Medicare does not cover routine dental, vision, or hearing care. Humana does: 100 percent of its 2026 non-SNP Medicare Advantage plans include all three, and so do all of its Dual-Eligible Special Needs Plans.⁶ Preventive dental is $0 across the board.

One Humana PPO plan’s benefit schedule shows what that looks like in practice:

Dental: up to $2,500 per year combined for preventive and comprehensive services. Exams, cleanings, and x-rays are $0, and on that plan crowns, root canals, bridges, dentures, extractions, and oral surgery are also $0, subject to frequency limits like one crown per tooth per lifetime.⁷
Vision: one routine eye exam per year at $0, plus up to $300 per year for eyeglasses or contact lenses, or $400 at a “PLUS” network provider.⁷
Hearing: one routine hearing exam per year at $0. Hearing aids through TruHearing run from $399 per aid (standard) to $999 per aid (premium), up to one aid per ear per year, with a 60-day trial, three-year warranty, and follow-up visits.⁷

Dollar amounts and frequency limits differ across plans. Check your plan’s Summary of Benefits or Evidence of Coverage for the exact numbers.

Mental Health and Telehealth

Humana plans cover outpatient and inpatient mental health care. Outpatient coverage includes psychiatric evaluations, medication management, family counseling as part of a treatment plan, and annual depression screenings at no cost. Providers can be psychiatrists, clinical psychologists, clinical social workers, nurse practitioners, or physician assistants.⁸

Inpatient psychiatric care in a general hospital follows the same cost-sharing as any other hospital stay. Care in a freestanding psychiatric hospital is subject to a lifetime limit of 190 days under Part A. Mental health medications fall under Part D, and federal rules require Part D plans to cover essentially all antidepressants, anticonvulsants, and antipsychotic drugs.⁸

Telehealth coverage must at least match Original Medicare and often goes beyond it.⁹ Virtual visits can handle routine check-ups, medication management, preventive screenings, mental health counseling, and specialty consultations. Some plans charge $0 for telehealth; the Humana Full Access PPO in Michigan, for example, lists $0 for primary care telehealth.¹ Humana partners with MDLIVE for on-demand virtual urgent care covering more than 80 conditions, plus talk therapy and psychiatry, and MDLIVE providers can prescribe during a visit.¹⁰

Skilled Nursing, Home Health, and Hospice

Skilled nursing facility stays follow the same general rules as Original Medicare, up to 100 days per benefit period. One Humana HMO plan charges $0 per day for the first 20 days and $218 per day for days 21 through 100. That same HMO also includes up to 44 hours per year of personal home care assistance with daily activities like bathing and dressing at no cost, provided services begin within 30 days of discharge from a hospital or SNF.¹¹

Home health care — part-time skilled nursing, physical therapy, and occupational therapy ordered by a doctor for homebound patients — is covered at $0.¹² Durable medical equipment like wheelchairs, hospital beds, and CPAP machines is also covered, with cost-sharing and supplier rules that vary by plan.¹³

One important boundary: hospice care stays under Original Medicare even when you’re enrolled in a Humana MA plan. Once you elect hospice, Original Medicare pays for everything related to the terminal illness. Your Humana plan continues to cover its supplemental benefits (dental, vision, and so on) and any medical care unrelated to the terminal condition.¹⁴

OTC Allowance, Meals, Transportation, and Fitness

Many Humana plans include a quarterly or monthly allowance for over-the-counter health and wellness products — vitamins, pain relievers, allergy medicine, first aid supplies — loaded onto a prepaid Humana Spending Account Card. Amounts are plan-specific; one standard PPO offers $60 per quarter.¹¹⁵

Some plans include post-discharge meal delivery through Humana Well Dine: two meals a day for seven days after an inpatient stay, up to four times a year, at $0.¹¹ Non-emergency medical transportation is available on certain plans through SafeRide Health, bookable online, by app, or by phone.¹⁶

Most Humana plans also include SilverSneakers at no extra cost, which covers participating gyms, community fitness classes, live online workouts, and an on-demand video library.¹⁷¹⁸ Humana’s Go365 wellness rewards program lets members earn points for healthy activities like flu shots or fitness classes and redeem them for rewards within the plan year.¹⁹ Not every plan in every area includes these programs, so verify through your Evidence of Coverage or MyHumana account.

Extra Benefits for Special Needs Plan Members

If you qualify for a Humana Special Needs Plan, the coverage goes well beyond a standard MA plan.

Dual-Eligible Special Needs Plans

D-SNPs are for people enrolled in both Medicare and Medicaid, and they combine benefits from both into one plan. Humana D-SNPs include $0 copays on hundreds of covered prescriptions — brand-name drugs included — with no drug deductible.²⁰ One D-SNP in Florida provides a $350 monthly Healthy Options Allowance, unlimited non-emergency transportation, up to 80 hours per year of personal home care, and a $2,000 annual dental allowance.²¹

Chronic Condition Special Needs Plans

C-SNPs are for members with specific severe chronic conditions. CMS recognizes 15 qualifying categories, including diabetes, cardiovascular disorders, chronic heart failure, chronic lung disorders, dementia, cancer, HIV/AIDS, end-stage renal disease, and chronic mental health conditions.²² Members of most Humana C-SNPs and D-SNPs who meet the criteria can use the Healthy Options Allowance, starting at $25 per month, for groceries, OTC items, utilities, rent, pet supplies, assistive devices, and more.²³

What You’ll Pay

About two-thirds of Humana’s 2026 Medicare Advantage plans have a $0 monthly premium. For plans that do charge one, the enrollment-weighted average is roughly $27 per month. You still pay the standard Medicare Part B premium, which is $202.90 per month in 2026.³ Some plans offer a Part B Giveback that reduces or eliminates that Part B premium; roughly a quarter of all MA plans nationwide offer the benefit for 2026, with the reduction amount varying widely.²⁴

Every plan has an annual out-of-pocket maximum. Once your cost-sharing hits the cap, the plan pays 100 percent of covered services for the rest of the year. The enrollment-weighted average across Humana’s plans is about $5,951, though individual plans go lower — one PPO lists $4,800 and a group PPO sets the cap at $1,200.³¹

What Is Not Covered

Even with the extras, some categories sit outside coverage. Long-term custodial care — nursing home stays, assisted living, and 24-hour in-home care — is not covered. Neither are cosmetic procedures like elective surgery or Lasik. Personal care assistance with daily activities like bathing, dressing, and eating is generally excluded unless it falls under a specific plan benefit such as post-discharge home care.²⁵

Plan Type and Prior Authorization

How you access covered care depends on which type of Humana plan you choose. HMO members generally must use in-network providers (except for emergencies) and need a referral from a primary care physician to see a specialist. PPO members can see out-of-network providers at higher cost and don’t need referrals. PFFS members can see any Medicare-approved provider willing to accept the plan’s payment terms. SNP network and referral rules depend on whether the plan is built as an HMO or PPO, and all SNPs include Part D.²⁶

Some services require prior authorization before Humana will pay. Humana publishes searchable prior authorization lists on its provider website, updated twice a year.²⁷ Starting in 2026, Humana has eliminated prior authorization for roughly one-third of outpatient services, including diagnostic procedures like colonoscopies, echocardiograms, and certain CT scans and MRIs. The company has also committed to deciding at least 95 percent of complete electronic prior authorization requests within one business day, and it has a “Gold Card” program that waives prior authorization for providers with strong track records.²⁸

Because benefits and networks vary by ZIP code, your plan’s Summary of Benefits or Evidence of Coverage is the definitive answer for what your specific Humana Medicare Advantage plan covers.

1
MedicareAdvantage.com. Humana Full Access H5216-287 (PPO) Summary of Benefits 2026
2
Humana. Medicare
3
NerdWallet. Humana Medicare Advantage Review
4
Humana. Compare Medicare Advantage Plans
5
Humana. Part D Drug Plans
6
Yahoo Finance. Humana 2026 Medicare Advantage Plans
7
MedicareAdvantage.com. Humana Full Access H7617-055 (PPO) Summary of Benefits 2026
8
Humana. Does Medicare Cover Mental Health
9
Humana. Does Medicare Cover Telehealth
10
MDLIVE. Humana Medicare Virtual Visits
11
MedicareAdvantage.com. Humana Gold Plus H1951-058 (HMO) Summary of Benefits 2026
12
Humana. Home Health Services
13
Humana. Durable Medical Equipment
14
Medicare.gov. Medicare Hospice Benefits
15
Humana. Over-the-Counter OTC Benefits
16
SafeRide Health. Humana Health Plan
17
Humana. Gym Membership
18
Humana. SilverSneakers
19
Humana. Achieving Health Goals
20
Humana. D-SNP Plans
21
MedicareAdvantage.com. Humana Dual Integrated (HMO D-SNP) Summary of Benefits 2026
22
CMS.gov. Chronic Condition Special Needs Plans
23
Humana. Healthy Options Allowance
24
MedicareResources.org. How the Medicare Part B Giveback Might Save You Money
25
Humana. What Does Medicare Cover
26
Medicare.gov. Compare Your Health Plan Options
27
Humana Provider. Prior Authorization Lists
28
Kiplinger. Humana to Reduce Prior Authorizations for Medicare Advantage Plans in 2026