Humana In-Network Medicare Doctors

Humana Medicare beneficiaries may or may not need to visit an in-network doctor in order to maximize their savings. 

In this guide, we’ll break down the difference between seeing an in-network vs. out-of-network health care provider with a Humana Medicare plan.

What Is an In-Network Doctor?

Insurance companies like Humana often contract with a network of participating doctors and other health care providers who agree to accept the reimbursement rate and other conditions of the insurance plan.

Each location will feature its own local network of Humana providers, and in some cases, plans may be accepted by providers outside of the member’s home area. 

Any health care provider who does not accept Humana insurance is considered an out-of-network provider.

Why Should You Visit Humana Network Doctors?

In some cases, receiving health care from a Humana in-network doctor will ensure that you maximize your health insurance coverage. But in some other limited cases, your out-of-pocket costs will be the same whether the health care provider is in-network or out-of-network. 

When Seeing a Humana In-Network Doctor Is Recommended

If you are enrolled in a Humana Medicare Advantage (MedicarePart C) plan, Medicare Part D prescription drug plan, or a Humana dental, vision or employer-sponsored plan, it’s recommended you receive care from a Humana in-network doctor or other provider. 

• Certain types of plans, such as an HMO (Health Maintenance Organization), require you to visit a Humana in-network doctor for your insurance plan coverage to be used. If you receive health care services from a provider who is not part of the Humana network, you will likely be responsible for the full cost of the service or items. (Emergency care is typically an exception to the rule.)
  
  
• Other types of plans, such as a PPO (Preferred Provider Organization), allow members to visit out-of-network doctors and still receive at least some coverage for the service or item in most cases. However, savings are still typically maximized when staying inside the Humana network for care. 

When It’s Okay to See an Out-Of-Network Provider

If you have a Humana Medicare Supplement Insurance (Medigap) plan, there is no need to visit a Humana in-network doctor.

Any health care provider who accepts Original Medicare (Medicare Part A and Part B) will accept a Medicare Supplement Insurance plan from any insurance company, and there is no difference in your out-of-pocket costs whether the provider is part of the Humana network or not. 

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How Do You Find a Doctor in Your Network?

Humana makes it easy to find an in-network doctor. Begin by using the Humana online provider search tool.

Choose your search radius, zip code and coverage type. Then, you may narrow your search even further by selecting a specialty, name or other criteria before clicking “Search.”

The results page will display a list of Humana in-network health care providers including their name, address, phone number and other information.

You may filter the results using any number of filters to the left and sort the results using the “Sort by” option at the top. You may even toggle between a list or map view of your results. 

Humana Provider Directory 2024

You can explore a list of Humana in-network Medicare doctors and other health care providers in your area.

Humana Medicare Advantage members may request a printed directory of providers and pharmacies by mail.

What Hospitals Are in the Humana Network? 

Emergency care is covered by a Humana plan regardless of whether the hospital is part of the Humana network.

For non-emergency services, use the Humana provider search tool to filter by location or specialty to see which hospital-based providers near you are part of the Humana network. 

And remember, a Humana Medicare Supplement Insurance plan may be used anywhere Original Medicare is accepted, regardless of whether the provider accepts other Humana insurance plans. The vast majority of hospitals in the U.S. accept Original Medicare. 

Medicare.gov, the official government website for Medicare, provides a handy and efficient way to compare hospitals in much the same way you might compare restaurants or hotels. Learn more about how to access and use the tool.

How Do I Change My Doctor With Humana? 

If your primary care physician or any of your regular health care providers are not part of the Humana network, you may change to doctors that do participate in the Humana network.

Contact a Humana representative at the phone number listed on your plan ID card or through the online MyHumana portal to update your primary care physician to one that is in the Humana network.

For other health care providers, simply locate ones that are in the Humana network using the Humana provider search tool and contact to request your appointment.