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The resources below give healthcare providers information about the types of Medicare Advantage plans Humana offers for individual Medicare beneficiaries. Included are operational and reimbursement guidelines, details about provider qualifications and requirements, frequently asked questions and other information.
The materials are for the 2021 plan year.
2021 Humana Medicare Advantage Health Maintenance Organization (HMO) plan
The following documents contain information about HMO and HMO point-of-service (HMO-POS) plans and HMO Special Needs Plans (SNPs).
2021 Humana Medicare Advantage Preferred Provider Organization (PPO) Plan
2021 Humana Medicare Advantage full and partial networks private-fee-for-service (PFFS) plans
Full and partial networks PFFS electronic claims flyer, PDF opens new window
Full and partial networks PFFS FAQs, PDF opens new window
Medicare Advantage PFFS plan model terms and conditions of payment, PDF opens new window
Other Medicare Advantage resources
Below are two programs to which Humana Medicare Advantage members may have access as part of their plan.
Medicare supplement insurance
This document explains Medicare supplement insurance (also known as Medigap) basics. It includes a chart of the standard Medicare supplement plans.
Medicare Outpatient Observation Notice
When a Medicare beneficiary receives outpatient observation services from a hospital or critical access hospital (CAH) for more than 24 hours, he or she (or the beneficiary’s authorized representative) must receive a Medicare Outpatient Observation Notice (MOON). The written MOON and a verbal explanation of the notice must be delivered no later than 36 hours after services were initiated. The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), enacted on Aug. 6, 2015.
Important notes:
- The MOON may be delivered before a beneficiary receives 24 hours of observation services as an outpatient
- If the beneficiary is transferred, discharged or admitted, the MOON still must be delivered no later than 36 hours following initiation of observation services
- The start time of observation services is measured as the clock time observation services are initiated in accordance with a physician’s order
Hospitals and CAHs must use the Office of Management and Budget (OMB)-approved MOON form, which can be downloaded from the Centers for Medicare & Medicaid Services (CMS) website , opens new window: