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Humana HMO: Key Things You Need to Know

Private insurance companies offer different kinds of health insurance plans. One of the most common types of plans they offer is HMOs. Humana is one of the leading private insurers offering HMO plans. If you want to enroll in an Humana HMO plan, you might have considered choosing one of Humana’s offerings. Here, we’ll explore their various Humana HMO plans to help you determine whether one of them is right for you.

What Is an HMO?

HMO stands for Health Maintenance Organization. It is a unique health insurance plan emphasizing coordinated and preventive care. HMOs usually have a network of doctors, hospitals, and other healthcare providers you must visit to receive covered services. This quality makes HMOs more cost-effective than other insurance plans.

Here are some key features that set HMOs apart from other health insurance plans:

Closed System

With an HMO plan, you must select a primary care physician (PCP) within your local network of service providers. Your PCP will coordinate your care and refer you to specialists when necessary. For instance, if you were to need the services of a dermatologist, you would first visit your PCP. Then, your PCP would refer you to a dermatologist within the HMO’s network.

Network Limitations

With an HMO plan, you will typically be restricted to visiting in-network providers for covered services. Out-of-network care usually isn’t offered, or it’s reserved for emergencies.

Lower Cost

Private insurers offering HMO plans negotiate for lower rates with service providers within their network, resulting in lower premiums and out-of-pocket costs for their members. This makes HMOs more affordable than other health insurance plans like preferred provider organization (PPO).

Additionally, HMOs typically have lower copayments and coinsurance, making them less costly. This makes HMOs affordable, particularly for individuals who only require basic medical care like annual preventive screenings and vaccines.

  • Types of Humana HMO Plans

    Humana offers a variety of HMO plans, though plan availability varies based on location. That said, here are some common plans they offer:
    Medicare Advantage HMO Plans
    Humana’s Medicare Advantage HMO plans are available to individuals who qualify for Medicare (age 65 or older), and they offer comprehensive coverage that includes all the benefits of Original Medicare (Parts A and B), plus other perks like prescription drug coverage, dental, vision, and hearing care.
    One of Humana’s most popular HMO plans is the Humana Gold Plus plan. The plan includes all the benefits of Original Medicare and other benefits, such as:
    Foreign travel emergency coverage
    Comprehensive coverage for most yearly preventive screenings
    Routine dental, vision, and hearing care
    Hospitalization coverage
    In addition to these benefits, some other plans may also provide other perks like:
    Caregiver support
    Mail-delivery pharmacies
    Fitness programs
    Local community centers
    $0 copays for virtual consultations with in-network primary care physicians

  • Humana Dental Health Maintenance Organization (DHMO)

    Humana’s DHMO plan offers comprehensive preventive dental care with no deductible. Some of its benefits include:
    Zero deductibles or waiting periods
    No maximum payment limit
    Convenient payment options via mail, phone, or online
    However, Humana’s DHMO plan is only available in certain states. Contact us at 561-90-SHARK to find out whether Humana offers it in your area.
    Find a Suitable HMO Plan
    A Humana HMO plan may be ideal if you only require basic medical care, don’t need to see specialists often, and are searching for a pocket-friendly health insurance plan.
    Want to learn more about Humana’s various HMO plans? Contact us today to speak to one of our Medicare experts.