Most people searching for Humana Medicare Advantage costs find a premium number and think that’s the whole bill. It isn’t. You’ll also owe a Part B premium every month no matter which plan you pick, and what you pay at the doctor’s office depends entirely on which plan type you enroll in, what county you live in, and whether your providers are in-network. This page breaks down every layer of cost, explains where the surprises hide, and matches each plan type to the situation it actually fits.
Key Takeaways — Short Answers First
People come to this page with very specific questions. The numbered cards below answer the most common ones directly, without the runaround.
Plan premiums range from $0 to roughly $100+ per month depending on your county and the plan type you choose. According to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium across all Medicare Advantage carriers is around $14. Humana’s HMO plans average about $3 a month, and more than 65% of all Humana Medicare Advantage plans carry a $0 monthly plan premium. But that is only the plan premium. You still owe your Medicare Part B premium of $202.90 a month on top of it — that bill comes from Social Security, not from Humana, and no Medicare Advantage plan eliminates it entirely (though some plans reduce it through a Part B giveback).
Yes — this is the number one thing that surprises new enrollees. Your Medicare Part B premium of $202.90 per month (the standard amount in the current benefit year) is separate from your Humana plan premium and is required by federal law as long as you are enrolled in Medicare. You pay it whether you’re on Original Medicare, a Medigap supplement, or any Medicare Advantage plan. Some Humana plans do offer a Part B giveback — a credit of anywhere from a few dollars up to $102 a month that Humana applies against your Part B bill — but that credit only partially offsets the cost and is only available on certain plans in certain counties. High earners pay more through IRMAA surcharges that can push the monthly Part B amount significantly above the standard $202.90.
On Humana’s most common in-network plans, the annual out-of-pocket maximum sits at $9,350 — the current CMS federal ceiling for Medicare Advantage. Once you hit that ceiling, Humana covers 100% of your covered in-network costs for the rest of the plan year. A handful of Humana plans cap your exposure much lower: some PFFS (private fee-for-service) plans set their limit at $7,550, and certain plans in select counties have maximums as low as $375. This annual cap is one of the key structural advantages over Original Medicare, which has no out-of-pocket limit at all — a single hospitalization on Original Medicare can cost you far more than $9,350 with no ceiling in sight.
Most Humana Medicare Advantage plans charge $0 for primary care visits with in-network providers — that applies to most non-special-needs plans. Specialist visits typically run a $35 to $50 copay per visit. Urgent care copays usually land around $40. Emergency room visits — not urgent care, but an actual emergency room — carry copays in the $90 to $120 range on most plans, which are waived if you’re admitted. Ambulance services typically run a flat copay around $300. These are plan-level averages; the exact copay on your plan depends on your county and the specific plan ID you enroll in. Getting a referral from your primary care doctor before seeing a specialist is required on HMO plans and skipping that step means you’ll pay full cost.
Most Humana Medicare Advantage plans include built-in Part D prescription drug coverage at no additional premium. In the current plan year, your total annual out-of-pocket cost on covered Part D drugs is capped at $2,100 — after that, you pay nothing on covered medications for the rest of the year. Many plans offer $0 copays on Tier 1 generic drugs, with higher tiers costing more. Insulin is capped at $35 per month. The annual drug deductible is $0 on many plans, though some plans charge up to the federal maximum of $615 for certain drug tiers. Humana also sells three stand-alone Part D plans (Value Rx, Premier Rx, Basic Rx) for people who want to stay on Original Medicare but need drug coverage.
Every single Humana Medicare Advantage plan in the current plan year includes routine dental, vision, and hearing coverage — none of those are optional add-ons. What varies is the depth of coverage. Preventive dental services (cleanings, X-rays) typically carry $0 copays. Vision includes annual eye exams with allowances for eyewear ranging from $100 to $300 depending on the plan. Hearing includes exams and annual allowances toward hearing aids, generally in the $500 to $1,500 range every one to three years. More comprehensive dental — crowns, dentures, implants — is available on higher-tier plans in select areas. Original Medicare covers none of these, which means the inclusion alone represents real dollar savings for most enrollees.
Humana offers Medicare Advantage plans in 46 states and Washington D.C., covering approximately 85% of all U.S. counties. States not currently covered by Humana MA plans include Alaska, Connecticut, Maine, and Wyoming. Availability within a state isn’t uniform — a county in a major metro area may have a dozen Humana plans to pick from, while a rural county may have two or three. Use Medicare.gov’s plan finder with your zip code to see exactly which Humana plans are available where you live, what each costs, and whether your current doctors are in the network. Humana’s own website at humana.com also allows zip-code lookups.
Yes, but only during specific windows. The main opportunity is the Annual Election Period (AEP): October 15 through December 7 each year — any change made during this window takes effect January 1. If you’re already in a Medicare Advantage plan and want to switch or go back to Original Medicare, the Medicare Advantage Open Enrollment Period (OEP) runs January 1 through March 31. Outside those windows, you can only make changes if you qualify for a Special Enrollment Period — triggered by events like moving to a new county, losing employer coverage, or qualifying for Medicaid. Missing the AEP and waiting a full year is one of the costlier mistakes Medicare beneficiaries make, especially if a plan raises copays or cuts benefits mid-enrollment.
Humana Plan Types — What Each One Costs and Requires
The plan type determines more than just your monthly premium. It decides whether you need a referral to see a specialist, whether you can go out of network, and how much flexibility costs you. Pick the wrong type and you may find yourself paying full price for a specialist visit simply because you didn’t call your primary care doctor first.
Humana’s flagship HMO, Gold Plus, is built for people who want low — often zero — out-of-pocket costs and are comfortable staying within a defined provider network. You choose a primary care physician (PCP) who coordinates all your care and issues referrals before you see any specialist. Skipping the referral and going directly to a specialist means you pay full cost. In exchange for that structure, you get some of the lowest copays available: most plans have $0 PCP visits, $0 preventive dental, $0 lab work, and $0 mammograms and colonoscopies. Annual out-of-pocket maximums run up to $9,350 in-network, but many Gold Plus plans in competitive markets set their MOOP lower. If most of your doctors are already in the Humana HMO network in your county, this plan type typically delivers the best cost control.
HumanaChoice PPO plans let you see any Medicare-accepting provider — in-network or out — without a referral and without being locked out of coverage. That flexibility comes at a price: out-of-network visits carry higher copays and coinsurance, and PPO premiums are generally higher than comparable HMO options (only about 15% of Humana PPO plans carry $0 premiums). If you travel frequently, split time between two states, or have a specialist you’re not willing to leave, the PPO structure gives you coverage wherever you go. Most PPO plans share the $9,250 to $9,350 MOOP for in-network care, with separate, higher limits for out-of-network costs. If your preferred specialist is out of network, verify the out-of-network MOOP before enrolling — it can be significantly higher than the in-network ceiling.
Private fee-for-service plans operate differently from HMOs and PPOs. There’s no fixed network — instead, any provider who agrees to the plan’s payment terms can treat you. That agreement must happen before each visit: you need to confirm in advance that your doctor accepts the plan’s terms, not just that they accept Medicare. Providers can decline, and there’s no guarantee they’ll agree. On the upside, some Humana PFFS plans carry a lower maximum out-of-pocket ceiling — $7,550 compared to the $9,350 HMO/PPO standard — which can matter if you expect heavy healthcare use. PFFS availability is limited to select counties and is less common than HMO or PPO options.
Humana’s Special Needs Plans serve two specific groups: people who qualify for both Medicare and Medicaid (Dual Eligible Special Needs Plans — D-SNPs), and people with certain serious chronic conditions such as diabetes, heart failure, or end-stage renal disease (Chronic Special Needs Plans — C-SNPs). These plans are often the most richly covered options available, with $0 copays on preventive services, vaccinations, and hundreds of prescription drugs. D-SNP members frequently pay $0 for virtually all covered services because Medicaid fills the gaps. If you’re enrolled in both Medicare and your state’s Medicaid program, you almost certainly qualify for a D-SNP and are leaving substantial money on the table if you’re not in one.
Humana Medicare Advantage Cost Breakdown, Side by Side
These figures reflect the current plan year’s published ranges. Exact costs depend on your county and specific plan ID. Always verify your plan’s Summary of Benefits before enrolling.
| Cost Type | HMO (Gold Plus) | PPO (HumanaChoice) | PFFS | D-SNP |
|---|---|---|---|---|
| Plan Premium | $0–$40/mo typical | $0–$100+/mo | Varies by county | Often $0 |
| Part B Premium (separate) | $202.90/mo — required on all plans · Part B giveback available on select plans | |||
| Medical Deductible | $0 on most plans | $0–$500 | Varies | Usually $0 |
| Primary Care Copay | $0 on most plans | $0–$20 in-network | Set by plan terms | $0 |
| Specialist Copay | $35–$50/visit | $45–$60 in-network | Set by plan terms | $0–$20 |
| Urgent Care Copay | ~$40 | ~$40–$65 | Varies | Often $0 |
| ER Copay (non-admit) | $90–$120 | $90–$120 in-network | Varies | $0–$90 |
| Annual MOOP (in-network) | Up to $9,350 | Up to $9,250 | $7,550 on some plans | Typically $0–$3,000 |
| Drug Deductible | $0 on most plans | $0–$615 | Varies | $0 |
| Annual Drug Cap (Part D) | $2,100 maximum — federal CMS limit applies to all plans | |||
| Specialist Referral Required? | Yes — from PCP | No | No | Depends on plan type |
| Out-of-Network Coverage? | Emergency only | Yes — at higher cost | Yes — if provider agrees | Usually in-network only |
Extra Benefits — What You Get That Original Medicare Doesn’t Cover
Every Humana Medicare Advantage plan comes with benefits that Original Medicare flat-out doesn’t pay for. These extras can offset hundreds or even thousands of dollars in annual spending — if you know how to use them. Note: many of these benefits were scaled back industry-wide due to rising medical costs, so verify what’s on your specific plan’s Summary of Benefits before counting on them.
All Humana Medicare Advantage plans include routine dental coverage. At the preventive level — cleanings, oral exams, X-rays — most plans charge a $0 copay. Restorative care (fillings, crowns, root canals) varies significantly: some plans cover it with copays, others cap annual dental spending at $500 to $2,000. More comprehensive dental, including dentures and implants, tends to appear on higher-cost plans or in competitive markets. Original Medicare covers dental only in narrow inpatient situations, so even a basic dental benefit here is genuinely new coverage. Check whether your dentist participates in the plan’s dental network — it may differ from the medical network.
All Humana plans include annual eye exams, typically with $0 to $20 copays. Beyond the exam, plans provide an annual allowance for eyeglasses or contact lenses — these allowances run from $100 to $300 depending on the plan and your county. Premium plans in more competitive markets sometimes include higher allowances. The allowance usually resets each plan year; unused funds don’t roll over. If you wear glasses and pay for them out of pocket now, even a $150 vision allowance more than covers a mid-range pair of frames and lenses from most optical retailers in-network.
Original Medicare provides essentially no hearing coverage — not exams, not aids, nothing unless it’s related to a covered medical procedure. Humana plans reverse that entirely. Most plans include annual hearing exams and allowances toward hearing aids ranging from $500 to $1,500, applied every one to three years depending on the plan. Copays for aids themselves range from about $399 to $699 per device depending on the technology level. Given that hearing aids typically cost $1,000 to $5,000 per pair out of pocket, even a partial Humana allowance represents meaningful savings.
Many Humana Medicare Advantage plans include a quarterly over-the-counter (OTC) allowance — money loaded onto a Humana Spending Account Card you can use to buy vitamins, pain relievers, first aid supplies, cold medicine, and similar health products. Allowances typically run $25 to $150 per quarter ($100 to $600 annually). Some higher-benefit D-SNP plans include a broader “Healthy Options Allowance” covering groceries, OTC items, and in some cases utilities — these can reach $260 or more per month on eligible plans. This is money that expires: unused balances generally don’t carry over to the next quarter, so set a reminder and spend it.
Many Humana plans include a SilverSneakers fitness membership, giving you free access to thousands of participating gyms and fitness centers nationwide — a benefit that would otherwise cost $25 to $50 a month. Humana’s Go365 wellness rewards program lets members earn points for healthy behaviors that can be redeemed for gift cards and merchandise. Some plans include rides to medical appointments — typically a set number of one-way trips per year. Worldwide emergency coverage is included on most plans, which matters if you travel internationally. These perks vary significantly by plan and are worth cross-checking on any plan you’re seriously considering.
Find Your Situation — Honest Advice for Each One
If you’re healthy, rarely see specialists, and your regular doctors are already in a Humana HMO network in your county, an HMO plan almost always delivers the best value. The $0 PCP copay and low premiums mean your actual monthly spending is close to just the $202.90 Part B. The mistake most first-timers make is choosing a PPO “for flexibility” without checking whether any of their doctors are actually out of network. Before enrolling in any plan, call each of your current doctors’ offices and ask specifically whether they accept Humana’s Medicare Advantage plan you’re considering — not just whether they accept Medicare. The networks are different, and one out-of-network specialist can cost you hundreds per visit on an HMO.
This is one situation where plan comparison is absolutely critical before enrolling — and where the free Medicare Plan Finder tool does most of the work. Enter your drug list at medicare.gov and it will show you the estimated annual cost on each plan available in your area. Key protections already built in: insulin is capped at $35 per month on all Medicare Advantage plans, and annual out-of-pocket spending on covered Part D drugs can’t exceed $2,100. But whether a specific drug is on a plan’s formulary — and what tier it’s in — determines your actual copay. A brand-name drug on Tier 3 may cost you $60 to $80 per month; if a generic equivalent exists on Tier 1, it could be $0. Bring your full medication list to any comparison and don’t enroll until you’ve confirmed coverage and tier placement for each one.
If a family member is enrolled in both Medicare and their state’s Medicaid program — called dual eligibility — they almost certainly qualify for a Dual Eligible Special Needs Plan (D-SNP). These plans are specifically designed for that overlap and typically carry $0 premiums, $0 copays on most services, and $0 on a broad list of prescription drugs. Many dual-eligible beneficiaries end up on standard Medicare Advantage plans by default and pay copays they legally don’t have to. If your family member is currently paying copays on a standard plan and is enrolled in Medicaid, call Humana directly or use the plan finder at medicare.gov to see if a D-SNP is available in their county. Switching during the Annual Election Period (October 15 to December 7) takes effect January 1.
It depends entirely on your plan type. An HMO plan covers you for emergency and urgently needed care anywhere in the U.S., but routine care while traveling — a sick visit, a prescription refill — generally isn’t covered if you’re outside your plan’s service area. A PPO plan covers routine care at out-of-network rates in any state, which means higher copays but actual coverage. For people who spend significant time in two states — Florida winters, summer up north — a PPO is usually the better call. All Humana Medicare Advantage plans include worldwide emergency coverage, meaning if you need emergency care abroad, it’s covered. Cruise travelers and anyone spending weeks outside their home county should confirm their plan type before assuming they have full coverage away from home.
Plans change their copays, deductibles, formularies, and premium amounts every January 1. Humana is required to send you an Annual Notice of Change (ANOC) by September 30 each year. Read it — even if you’ve been on the same plan for five years. A copay increase of $15 per specialist visit sounds small, but if you see three specialists monthly, that’s $540 a year you didn’t budget for. The Annual Election Period (October 15 to December 7) exists exactly for this moment: it’s your window to shop, compare, and switch without penalty. Use medicare.gov’s plan finder with your current doctor list and drug list, sort by estimated annual cost, and compare at least three options. Independent Medicare brokers can also do this comparison at no cost to you — they’re compensated by the insurers, not by you.
Your Humana plan premium is the same regardless of income — income doesn’t affect Medicare Advantage plan premiums. But your Medicare Part B premium does increase with income through a system called IRMAA (Income-Related Monthly Adjustment Amount). In the current benefit year, individuals whose income from two years prior exceeded $106,000 pay more than the standard $202.90, with surcharges reaching over $500 per month at the highest income brackets. Married couples filing jointly see different thresholds. If your income has dropped significantly since then — due to retirement, a one-time event, or other changes — you can appeal your IRMAA surcharge using SSA Form SSA-44 and request reassessment based on current income. Getting IRMAA reduced is one of the most overlooked savings opportunities for newly retired seniors.
Where to Compare Plans and Get Help
Official resources only. Confirm costs and coverage directly before enrolling — plan details change every year.
Cost data and plan details in this article are based on published figures from the Centers for Medicare & Medicaid Services (CMS), Humana’s official plan announcements for the current benefit year, and independent analysis from U.S. News & World Report’s Medicare research team. Key sources: CMS.gov; Humana.com; Medicare.gov. Plan premiums, copays, deductibles, out-of-pocket maximums, and extra benefits vary by county and specific plan ID — figures shown are ranges for illustration. Always review a plan’s Summary of Benefits before enrolling. This page is independent and is not affiliated with Humana Inc., CMS, or any insurance carrier. Medicare plan details change annually; verify all information with your plan or a licensed Medicare counselor before making coverage decisions.
The State Health Insurance Assistance Program (SHIP) provides free, unbiased Medicare counseling through federally funded local advisors in every state.