Humana Medicare Advantage PPO Plans

Welcome to the world of Humana Medicare Advantage PPO Plans, where healthcare freedom and flexibility take the spotlight.

Imagine having the liberty to choose your doctors and specialists, coupled with a comprehensive coverage that caters to your unique healthcare needs. This is the essence of Humana’s Medicare Advantage PPO plans for 2025.


Key Takeaways



  • Humana provides non-discriminatory healthcare services in 200 languages with free interpreter services available via phone call, adhering to relevant civil rights laws.

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Understanding Humana Medicare Advantage PPO Plans

Humana, a notable provider of Medicare Advantage HMO, PPO, and PFFS plans, presents Medicare Advantage PPO Plans.

These plans consolidate the advantages of Medicare Parts A and B, and frequently Part D, into a single plan. These plans are available in states like MD, ME, MI, and MN: Maryland, Maine, Michigan, and Minnesota.

They provide broader coverage than Original Medicare, including benefits like dental and vision that are typically not covered by Original Medicare.


Understanding Humana Medicare Advantage PPO Plans

Humana offers the following plan types in states like CA, CT, DC, and DE, as well as in NY, OH, and PA.


  • PPO plans, which provide greater freedom in selecting healthcare providers
  • HMO plans require the selection of a primary care physician and referrals for specialist care
  • PFFS plans, which do not have a network of participating providers


Each plan type has its distinct benefits and factors to consider.


Humana medicare advantage plans with dental



How PPO Plans Work

A PPO plan in health insurance serves as a connector, linking you to a network of healthcare providers for medical care, regardless of age, disability, gender, or sexual orientation.

Consider having a health insurance guide, that leads you to medical services from providers outside of your network. This is the core functioning of a Medicare Advantage PPO plan. It covers Medicare-covered services and additional benefits, such as dental and vision, that are not covered by Medicare.

In-network providers in a PPO plan are akin to allies who have consented to provide services at a reduced rate, irrespective of the patient’s gender identity or expression, identity or expression of transgender, expression of transgender status marital, or transgender status.

Conversely, the out-of-network providers are akin to contacts who might levy the full rate, typically higher than the rate within the network.

Need to see a specialist?

No worries! With a Medicare Advantage PPO plan, you can see any doctor or specialist within the network without the need for a referral.


Comparing PPO and HMO

Visualizing the distinctiveness between PPO and HMO plans can be compared to contrasting a vast ocean with a regulated pool. PPO plans, like an ocean, allow you a broader network of doctors and hospitals to choose from and do not necessitate referrals to see specialists.

However, HMO plans, like a pool, have a more restricted network, require a referral from a primary care physician, and generally do not cover out-of-network care, except in cases of emergency.

Regarding cost-sharing, PPO plans resemble a premium restaurant, providing more flexibility and options for out-of-network care, albeit at a greater cost. HMO plans, on the other hand, are like a budget-friendly eatery, often with lower premiums and deductibles, but necessitate staying within the network for care.

Coverage and Benefits of Humana Medicare Advantage PPO Plans

Humana Medicare Advantage PPO plans resemble a multi-tool, bestowing a broad range of benefits to its members. In addition to the flexibility of selecting a physician who is best suited for your medical requirements, these plans also provide prescription drug coverage, with the potential for significant savings on medications.


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Analogous to a treasure chest, Humana Medicare Advantage PPO plans accompany numerous extra benefits. These include:


  • Extra services
  • Dental coverage
  • Vision coverage
  • Hearing coverage
  • Healthy Options Allowance benefit which covers certain foods and personal supplies.


Prescription Drug Coverage

Consider having a safety buffer for your prescription drug requirements – that’s what the Humana Medicare Advantage PPO plans provide. These plans include prescription drug coverage, similar to that of a standard Medicare Part D plan, providing coverage for a wide range of prescription drugs.

However, every safety net might have some gaps. Certain medications under the Humana Medicare Advantage PPO plan’s drug coverage may require prior authorization or have quantity limits.

But fear not, for Humana offers multiple ways to save on medications, such as prescription savings options, discounts on medicines, and potential savings on over-the-counter drugs.


Additional Benefits

Beyond the regular Medicare-covered services, Humana Medicare Advantage PPO Plans reveal a multitude of extra benefits. Dental coverage, for instance, is generally provided.


Compare medicare advantage plans 2023



Now, doesn’t that bring a smile to your face?

Moreover, other vision benefits such as:


  • annual eye exams
  • an annual allowance for eyeglasses or contact lenses
  • glaucoma screenings
  • diabetic eye exams


are available. And for those looking to stay fit and active, Humana offers the SilverSneakers fitness program as an additional benefit.

Costs and Savings with Humana Medicare Advantage PPO Plans

Comprehending the costs tied to Humana’s PPO plans is akin to mastering the rules of a game. The average costs may vary depending on the specific plan and location, but the projected average premium for a Medicare Advantage plan in 2024 is estimated to be $18.50 per month.


Best humana medicare advantage plan Keep in mind that there could be other costs to consider, such as co-pays and deductibles.

As every game possesses its strategies, there are methods to optimize your savings with Humana’s PPO plans.

Premiums are determined based on a variety of considerations, such as the specific plan selected, geographic location, and age.

Generally, PPO plans tend to have higher monthly premiums compared to other Medicare Advantage plans. However, using preferred (in-network) providers can help lower your out-of-pocket costs.


Out-of-Pocket Maximums

Out-of-pocket maximums in a PPO plan function as a financial safety buffer, shielding you from exorbitant medical expenses.

The out-of-pocket maximum is the maximum amount of money that an individual must pay for covered in-network services in a calendar year. On average, the limit for Medicare Advantage PPO plans is around $4,835 for in-network services and $8,659 for both in-network and out-of-network services.

Upon reaching this limit, it equates to crossing a financial finish line – the health insurance company will shoulder 100% of the in-network expenses for the rest of the year, guaranteeing that no extra medical costs will be borne beyond the maximum limit.


Saving with Preferred Providers

Opting for preferred providers in Humana PPO plans offers several benefits:


  • You obtain the same caliber of services as out-of-network providers
  • You can potentially pay less for your healthcare services
  • Preferred providers have negotiated rates with Humana, which are typically lower than those of out-of-network providers


So, staying within the lower-cost preferred pharmacies network can help you take advantage of these negotiated rates and save money on your healthcare expenses.

Finding preferred providers is simple, too. Just like using a map to find a location, you can use the Humana online provider search tool to locate doctors and healthcare providers that are in-network and preferred by Humana.

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Navigating Dual Eligible Special Needs Plans (D-SNP)

Visualize a health plan specifically tailored for individuals who qualify for both Medicare and Medicaid.

This is what a Dual Eligible Special Needs Plan (D-SNP) is – a type of Medicare Advantage plan that provides additional benefits and services, such as:


  • coverage for prescription drugs
  • dental services
  • vision services
  • hearing services


Our program is designed to meet the unique needs of dual-eligible individuals, regardless of their military or veteran status.

These plans provide comprehensive coverage for hospital, medical, and prescription costs, usually with minimal or no out-of-pocket expenses. They have provider networks and offer specialized care and wrap-around services to meet the specific needs of dual-eligible individuals.

So, if you meet the criteria of being entitled to both Medicare (Parts A & B) and medical assistance from Medicaid, a D-SNP could be a great fit for you.

Non-Discrimination and Accessibility in Humana Medicare Advantage PPO Plans

Humana’s pledge to non-discrimination and accessibility resembles a welcome mat at the entrance, extending an invitation to all members to avail quality healthcare services without prejudice.


Non-Discrimination and Accessibility in Humana Medicare Advantage PPO Plans




Humana is dedicated to providing non-discriminatory and accessible services to all of its members.

It’s like a shield, protecting its members from any form of discrimination based on:


  • race
  • color
  • national origin
  • age
  • disability
  • sex
  • sexual orientation
  • gender
  • status military or veteran
  • veteran status or religion


Humana Inc. and its subsidiaries adhere to all relevant federal civil rights laws, ensuring that their services are accessible and equitable for all members.


Free Language Interpreter Services


Language Interpreter Services



Similar to how a translator assists in bridging language gaps, Humana’s complimentary language interpreter services ensure effective communication with healthcare providers.

These services are available in 200 languages, providing oral interpretation and video interpretation in 24 languages.

Accessing these services is as easy as a phone call. Humana members can simply call the number on the back of their member ID card or call 1-877 (TTY: 711) to access language interpreter services.


Compliance with Anti-Discrimination Laws

Adherence to anti-discrimination laws serves as a moral compass for Humana. These laws, prohibit discrimination based on:


  • race
  • color
  • national origin
  • age
  • disability, sex, sexual orientation, gender identity


guide Humana’s commitment to providing equal access to healthcare services.

Just as a compass points north, Humana adheres to these laws by providing language assistance services and accommodations for individuals with disabilities, ensuring equal access to their Medicare Advantage PPO plans.

Enrolling in a Humana Medicare Advantage PPO Plan

To register for a Humana Medicare Advantage PPO Plan, you must fulfill certain qualifications:


  • Age 65 or older
  • Younger than 65 with a qualifying disability
  • With end-stage renal disease (ESRD), permanent kidney failure necessitates dialysis or a kidney transplant.


Just like there are specific seasons for certain activities, there are specific enrollment periods for Humana Medicare Advantage PPO Plans.

The Open Enrollment Period runs from October 15th to December 7th annually, and the Medicare Advantage OEP runs from January 1st to March 31st.


Navigating the healthcare landscape can sometimes feel like traversing a dense forest. But with Humana Medicare Advantage PPO Plans, you have a map in hand. These plans offer greater flexibility in selecting healthcare providers, comprehensive coverage, and additional benefits that cater to your unique healthcare needs.

By understanding the costs associated with these plans and utilizing preferred providers, you can maximize your savings.

Humana’s commitment to non-discrimination and accessibility ensures that the door to quality healthcare is open for all. So, step into a world of healthcare freedom with Humana Medicare Advantage PPO Plans – your journey to better health starts here.

Frequently Asked Questions



What is the difference between Humana HMO and PPO?

Humana HMOs have smaller networks than PPOs, require referrals to see specialists, and come with lower monthly premiums and out-of-pocket costs.

PPOs have larger networks, more flexibility to use providers in or out of the network without a referral, and generally higher premiums.


Is Humana Choice PPO a Medicare replacement plan?

Humana Choice PPO is a type of Medicare Advantage (Medicare Part C) plan, and thus is a Medicare replacement plan. It covers the same benefits as Original Medicare (Part A and Part B), plus may include prescription drug coverage and other benefits.


Is Humana Medicare and Humana Medicare Advantage the same?

Humana is a private insurance company that works along with Original Medicare with their Medigap policies, and as an alternative to Original Medicare with their Medicare Advantage plans.

Humana Medicare Advantage is a private insurance plan offered by Humana and covers the same healthcare services as Original Medicare, except for hospice care. It also provides additional benefits like wellness programs and support.


What is a Humana Medicare Advantage PPO Plan?

Humana Medicare Advantage PPO Plans are comprehensive healthcare solutions that combine the benefits of Medicare Parts A, B, and D, often including additional coverage like dental and vision.


→  What are the additional benefits offered by Humana’s PPO plans?

Humana’s PPO plans may offer additional benefits such as prescription savings, dental, vision, and hearing coverage, and the Healthy Options Allowance benefit.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.