Among the most important features of any health insurance plan is the selection of doctors and other health care providers who accept the payment terms and conditions of the plan.
If you are enrolled in a Humana Medicare Advantage (Medicare Part C) plan, you can likely save on your out-of-pocket health care costs by visiting doctors in your Humana plan network.
Whether or not your doctor will accept your Humana Medicare Advantage plan depends on what plan you have and whether your doctor is in your plan network.
Learn more about how to find doctors and other providers that accept your Humana Medicare Advantage plan and how you may be able to pay less out of pocket for your care.
How do I find a doctor that accepts a Humana Medicare Advantage plan?
It’s easy to find a doctor who will accept your Humana Medicare Advantage plan.
- If you’re a current Humana Medicare Advantage plan member, you can simply use the Humana provider locator tool to search for in-network doctors, hospitals and other health care providers.
- If you’re considering a Humana Medicare Advantage plan and want to find a plan that accepts your current doctor, you can call a licensed insurance agent1 directly at 1-800-472-2986 TTY Users: 711 24 hours a day, 7 days a week. You can also request a free plan quote online to compare your options, with no obligation to enroll in a plan.
Do Humana Medicare Advantage plans have provider networks?
Humana offers several different types of Medicare Advantage plans. Each type of plan may contract with specific doctors, hospitals, clinics and other health care providers who agree to provide services to Humana plan members for less than what they may typically charge.
Some of the types of Humana Medicare Advantage plans that you may be able to choose from can include:
- Humana Gold Plus® HMO
With a health maintenance organization (HMO) plan, you will choose a primary care physician (PCP) within the plan network. Your PCP works with you to coordinate your health care, and you are generally required to get a referral from your PCP to see other health care providers for specialized care.
You will typically pay lower out-of-pocket costs (such as copayments and deductibles) if you visit in-network doctors. In fact, the Humana Gold Plus HMO plan covers you for unlimited medical doctor visits with affordable copayments, as long as your PCP is in your Humana plan network.
You should check with your doctor to make sure they are in your plan network and accept Humana’s terms and conditions before receiving care. You may be responsible for paying some or all of your medical costs for out-of-network care, except in the case of an emergency.
- HumanaChoice® PPO
A preferred provider organization (PPO) plan allows you the flexibility to visit any Medicare-approved doctor — in or out of the network — who agrees to accept the terms and conditions of the plan, though you will typically face lower out-of-pocket costs by visiting a doctor who is in the Humana plan network.
You aren’t required to get a referral in order to see a specialist, in most cases. Some services, however, may require plan prior authorization.
As with other health insurance plans, you should ask your doctor if they accept the plan terms before you receive any treatment, or else you could be responsible for paying some or all of your medical costs.
- Humana Gold Choice® PFFS
With the Humana Gold Choice private fee-for-service (PFFS) plan, you can visit almost any Medicare-approved doctor you choose, as long as they accept Humana’s plan terms and agree to bill the plan.
Check with your doctor to see if they accept the plan terms before you receive any treatment, or you may be responsible for paying some or all of your medical costs.
What types of doctors might be in a Humana health insurance network?
Every health insurance plan may have different rules for in-network and out-of-network coverage costs and the types of providers you can visit under the plan.
The types of doctors and other health care providers that could potentially be in your plan network may include:
- Primary care physicians
- Outpatient clinics
- Mental and behavioral health practitioners
- Skilled nursing facilities
- Surgical centers
- Durable medical equipment (DME) suppliers
- Optometrists and opthamologists
Humana Medicare Advantage plans may also include contracted retail and mail order pharmacies, depending on the type of plan you have and whether your plan offers benefits for prescription drug coverage.
If you need help finding a Humana Medicare Advantage plan that accepts your current doctor, you can call a licensed insurance agent1 directly at 1-800-472-2986 TTY Users: 711 24 hours a day, 7 days a week. You can also request a free plan quote online to compare your options, with no obligation to enroll in a plan.