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Medicare and Medicaid information

This webpage offers publications and other information for healthcare professionals who treat patients with Humana Medicare, Medicaid and dual Medicare-Medicaid coverage.

Doctor examining senior female patient

Publications

Medicare private-fee-for-service (PFFS)

Terms and conditions for Medicare PFFS

Medicare PFFS, PDF

Medicare Advantage materials

Operational and reimbursement guidelines, provider qualifications and requirements, frequently asked questions and other information

Medicare Advantage materials

Medicaid and dual Medicare-Medicaid provider materials

State-specific resources for Humana Healthy Horizons (Medicaid) products

Humana Healthy Horizons® in Florida (Medical and Long-Term Care plans)

Humana Healthy Horizons® in Indiana

Humana Healthy Horizons® in Kentucky

Humana Healthy Horizons® in Louisiana

Humana Healthy Horizons® in Ohio

Humana Healthy Horizons® in Oklahoma

Humana Healthy Horizons® in South Carolina

State-specific resources for Humana Gold-Plus® Integrated (dual Medicare-Medicaid) products

Illinois Medicare-Medicaid

Provider manuals

Florida materials

2022 Humana Healthy Horizons in Florida provider manual – effective March 2, 2022, PDF

2023 Humana Healthy Horizons in Florida provider manual – effective October 1, 2023, PDF

Illinois materials

2022 Illinois-CMS-sponsored Medicare-Medicaid Alignment Initiative (Demonstration) Manual – effective October 10, 2022, PDF

Kentucky materials

2022 Humana Healthy Horizons in Kentucky provider manual – effective June 16, 2022, PDF

2023 Humana Healthy Horizons in Kentucky provider manual – effective March 15, 2023, PDF

Louisiana materials

2023 Humana Healthy Horizons in Louisiana provider manual – effective January 1, 2023, PDF

Ohio materials

2023 Humana Healthy Horizons in Ohio provider manual – effective February 1, 2023, PDF

South Carolina materials

2022 Humana Healthy Horizons in South Carolina provider manual – effective September 1, 2022, PDF

Other resources

National coverage determinations

Learn about the latest changes the Centers for Medicare & Medicaid Services (CMS) has made to services that are covered by Medicare.

National coverage determinations

Special needs plans presentation

Learn about the special needs plans (SNPs) we offer in select states and the critical role you play in the care of our SNP members.

Special needs plan presentation 2021, opens new window

Quality materials

Visit our quality resources page for information on CMS Star Ratings, the Healthcare Effectiveness Data and Information Set (HEDIS®), the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), the CMS Health Outcomes Survey (HOS) and more.

Quality materials