If you live in Sebring, Avon Park, Lake Placid or anywhere in Highlands County, Humana Medicare Advantage may be a plan you are comparing, or the plan you already have. If you are thinking about Humana for Medicare, or you already have a Humana plan, the big questions are simple: how does Humana work with Medicare, and how does it work with your doctor? This guide answers both in 5 points, using information from Medicare.gov and Humana. At Shield Medical Group in Sebring, we accept all Humana plan types, including Humana HMO and PPO plans.
1. What is Humana Medicare Advantage?
It is a Medicare Advantage (Part C) plan: a Medicare-approved plan from a private company, Humana, that offers an alternative to Original Medicare for your health and drug coverage.
Medicare.gov explains that Medicare Advantage plans bundle your Part A (hospital) and Part B (medical) coverage, and most plans also include Part D drug coverage. These plans are offered by private companies that must follow rules set by Medicare.
Humana’s website lists several types of Medicare Advantage plans, including health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, Special Needs Plans (SNPs) and private fee-for-service (PFFS) plans.
To join any of these plans, you must have both Medicare Part A and Part B and live in the plan’s service area.
- Includes Part A (hospital insurance)
- Includes Part B (medical insurance)
- Most plans include Part D (drug coverage)
- Must have Part A and Part B to join
Sources: Your coverage options (Medicare.gov); Medicare & You 2027 handbook (Medicare.gov); Humana Medicare Advantage plans (Part C) (Humana); Joining a plan: enrollment periods (Medicare.gov)
2. Humana with Medicare: is it a Medicare replacement?
No. Joining a Humana plan does not replace Medicare. Medicare.gov says that when you join a Medicare Advantage plan you still have Medicare, but you get most of your Part A and Part B coverage from the plan instead of Original Medicare.
Some people search for a Humana Medicare replacement plan. The phrase is common, but it can be confusing. Humana with Medicare means Humana manages your Medicare benefits through its plan; you are still a person with Medicare.
Medicare.gov says you must use the card from your Medicare Advantage plan to get your Medicare-covered services. Keep your red, white and blue Medicare card in a safe place, because you may need it later.
Medicare.gov also notes that you keep paying your monthly Part B premium when you join a Medicare Advantage plan, and you may also pay the plan’s premium.
- Step 1: Have Medicare Part A and Part B.
- Step 2: Join a Humana Medicare Advantage plan.
- Step 3: Show your Humana card for care.
- Step 4: Keep your Medicare card safe.
Sources: Medicare & You 2027 handbook (Medicare.gov); Compare Original Medicare & Medicare Advantage (Medicare.gov)
3. How Humana Medicare Advantage works with your doctor
With a Medicare Advantage plan, the network matters. You may need to use doctors in the plan’s network, and some plans require a primary care doctor and referrals for specialists.
Medicare.gov explains that with an HMO you generally must get care from doctors and hospitals in the plan’s network, except for emergency care, out-of-area urgent care and temporary out-of-area dialysis. In most HMOs you need to choose a primary care doctor, and in most cases you need a referral to see a specialist.
With a PPO, Medicare.gov says you pay less when you use providers in the plan’s network. You can generally see out-of-network providers for covered services, but you will usually pay more, and you do not need a referral to see a specialist.
Medicare.gov adds that with a Medicare Advantage plan you may need approval from your plan, called prior authorization, before it covers certain services or supplies.
Humana says its HMO members choose a primary care physician from the plan’s network, and members can change that doctor as often as they like. Our Sebring practice accepts all Humana plan types, so your Humana HMO or PPO plan works with our doctors.
- HMO: usually choose a primary care doctor and get referrals
- PPO: in network costs less; out of network usually costs more
- Some services may need prior authorization
- Shield Medical Group in Sebring accepts all Humana plan types
Sources: Health Maintenance Organizations (HMOs) (Medicare.gov); Preferred Provider Organizations (PPOs) (Medicare.gov); Compare Original Medicare & Medicare Advantage (Medicare.gov); How do I change my primary care doctor on Medicare? (Humana); Primary Care Doctor in Sebring, FL (Shield Medical Group, Sebring office page)
4. What Humana Medicare Advantage covers and costs
Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and they have a yearly limit on what you pay for covered Medicare services.
According to Medicare.gov, Medicare Advantage plans may also offer extra benefits that Original Medicare does not cover, like some vision, hearing and dental services. Most plans include Medicare drug coverage (Part D), so you do not pay a separate Part D premium.
Out-of-pocket costs vary by plan. Once you reach your plan’s yearly out-of-pocket limit, you pay nothing for covered services for the rest of the year. You cannot buy a Medigap policy to cover costs in a Medicare Advantage plan.
Many Humana plans include routine dental, vision and hearing coverage, and Humana says some of its plans offer $0 copays for visits to in-network primary care providers. Check your plan’s Evidence of Coverage for your exact benefits and costs.
- Original Medicare: any doctor that takes Medicare
- Original Medicare: separate Part D drug plan
- Original Medicare: no yearly out-of-pocket limit
- Medicare Advantage: plan network in many cases
- Medicare Advantage: most plans include Part D
- Medicare Advantage: yearly out-of-pocket limit
Sources: Compare Original Medicare & Medicare Advantage (Medicare.gov); Humana Medicare Advantage plans (Part C) (Humana)
5. Choosing Humana for Medicare: when you can join or switch
You can join, switch or drop a Medicare Advantage plan only during certain enrollment periods, such as Open Enrollment from October 15 to December 7.
Medicare.gov lists the main times. During Open Enrollment, October 15 to December 7, you can join, switch or drop a Medicare Advantage plan, and coverage starts January 1. If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period runs January 1 to March 31. Special Enrollment Periods apply after certain life events, such as moving.
Before you choose Humana for Medicare coverage, Medicare.gov suggests checking that the plan covers your prescriptions and asking your doctors and pharmacies whether they are in the plan’s network.
For free, unbiased help comparing plans, Florida’s SHINE program offers one-on-one Medicare counseling through the Florida Department of Elder Affairs.
- Oct 15 to Dec 7: Open Enrollment; join or switch plans.
- Jan 1: New plan coverage starts.
- Jan 1 to Mar 31: Medicare Advantage members can switch plans.
- Life events: Special Enrollment Periods may apply.
Sources: Joining a plan: enrollment periods (Medicare.gov); SHINE (Serving Health Insurance Needs of Elders), Florida Department of Elder Affairs
Using your Humana Medicare Advantage plan at Shield Medical Group in Sebring
Shield Medical Group in Sebring accepts all Humana plan types, including Medicare Advantage HMO and PPO plans, such as Humana Gold Plus HMO. Call (863) 236-9550 to book.
Our Sebring office at 4597 Casablanca Cir offers adult primary care, Medicare Annual Wellness Visits, care for long-term conditions such as diabetes and high blood pressure, same-day sick visits and walk-ins during office hours.
Medicare.gov describes the yearly Wellness visit as a visit to build or update a personalized prevention plan. If you have a Humana plan, check your plan’s costs for preventive visits.
Benefits such as copays and referral rules differ from one Humana plan to another. If you have questions about your benefits, call our office or the Member Services number on the back of your Humana card.
Sources: Primary Care Doctor in Sebring, FL (Shield Medical Group, Sebring office page); Yearly “Wellness” visits (Medicare.gov)
Related: Humana Doctors in Sebring, FL: 2 Trusted Doctors, All Plans Accepted
Related: Primary Care Doctors in Sebring, FL
Related: MOOP Medicare Advantage: 5 Facts About Your Best Safety Net
Related: Medicare Advantage: Check Your Doctors in 3 Steps
Related: Medicare Advantage AEP: 5 Tips to Win Open Enrollment
Related: Annual Wellness Visit
Frequently asked questions
How does Humana Medicare Advantage work?
It is a Medicare-approved plan from a private company. It bundles your Part A and Part B coverage, and most plans include Part D. You use your Humana card for care, and many plans use a provider network.
Is Humana Medicare Advantage a replacement for Medicare?
No. Medicare.gov says you still have Medicare when you join a Medicare Advantage plan; you get most of your Part A and Part B coverage from the plan instead of Original Medicare.
How does Humana work with Medicare?
Humana is a private company that offers Medicare-approved plans and must follow rules set by Medicare. With a Humana Medicare Advantage plan you still have Medicare, you keep paying your Part B premium, and you may also pay the plan’s premium.
What does Humana Medicare Advantage cover?
It must cover all medically necessary services that Original Medicare covers. Many Humana plans include routine dental, vision and hearing coverage. Check your plan’s Evidence of Coverage for your exact benefits.
Who accepts Humana Medicare Advantage in Sebring?
Shield Medical Group in Sebring accepts all Humana plan types, including Medicare Advantage HMO and PPO plans. Call (863) 236-9550 to book a visit.
References
- Primary Care Doctor in Sebring, FL (Shield Medical Group, Sebring office page)
- Medicare & You 2027 handbook (Medicare.gov)
- Your coverage options (Medicare.gov)
- Compare Original Medicare & Medicare Advantage (Medicare.gov)
- Health Maintenance Organizations (HMOs) (Medicare.gov)
- Preferred Provider Organizations (PPOs) (Medicare.gov)
- Joining a plan: enrollment periods (Medicare.gov)
- Humana Medicare Advantage plans (Part C) (Humana)
- How do I change my primary care doctor on Medicare? (Humana)
- SHINE (Serving Health Insurance Needs of Elders), Florida Department of Elder Affairs
- Yearly “Wellness” visits (Medicare.gov)
Educational only; talk to your clinician. This article is general health education, not medical advice, diagnosis or treatment.
