Questions and answers about the Humana Group Medicare Advantage PPO plan

How is the Humana coverage offered through the Board different from other Medicare Advantage plans?

The Humana Group Medicare Advantage PPO and Humana Group Medicare Prescription Drug Plan (PDP) are group plans, which are very different from individual Medicare Advantage and Part D plans available in your local market. There are $0 copays for many types of healthcare services, such as preventive care and primary doctor’s office visits, and no annual deductible.

While Humana has one of the largest PPO networks, the Board has secured a passive PPO plan, which means you can go to any provider that accepts Medicare and will bill Humana. Humana will reimburse that provider at 100% of the Medicare-allowed amount. Another notable difference is that the PDP’s prescription drug formulary has significantly more prescription drug options than the standard individual formulary.

Can I enroll for medical coverage under the Humana Group Medicare Advantage PPO plan without enrolling in the Humana Prescription Drug Plan (PDP)?

Enrollment in post-retirement medical coverage is for both Humana plans (PPO and PDP). You cannot enroll in one without the other.

Will I have separate ID cards for medical and prescription coverage?

Starting Jan. 1, 2026, the Humana coverage available through the Board of Pensions will be administered as two separate plans — a Medicare Advantage Preferred Provider Organization (PPO) (Medicare Part C) and a Prescription Drug Plan (Medicare Part D).

This means you will receive two Humana ID cards for 2026:

• a medical ID card to use at the doctor’s office, hospital, or other healthcare providers
• a prescription drug ID card to use at network pharmacies

These cards will arrive separately in the mail.

Most prescriptions and vaccines will be covered through your pharmacy benefit (prescription drug ID card), but some items, such as diabetic testing supplies, flu vaccines, and commonly used nebulized medications, may be covered through your medical benefit (medical plan ID card). If you are unsure of which card to use, present your pharmacy with both cards and let them know you have both prescription drug and medical coverage through Humana.

Do I have to use a network doctor, specialist, or hospital to receive benefits under the plan?

Having a relationship with your primary care provider is important. While Humana offers a large national network of contracted providers, under the plan you can use any provider who accepts Medicare and agrees to bill Humana. Your plan coverage remains the same, even if you receive care from an out-of-network provider.

What if my physician accepts Medicare but isn’t in the Humana network?

If your physician accepts Medicare but isn’t in the Humana network, you should ask that they bill Humana directly. The reimbursement will be no less than what Medicare allows. You can call the Humana Customer Care team at 855-273-0021 (TTY: 711) and a Humana representative can call your provider to explain how your plan works and confirm the provider will submit claims to Humana.

Does Humana have to approve care or services from my doctor before I receive benefits?

Certain medical services and procedures or medications may need advance approval from Humana — called prior authorization. Your provider typically handles the prior authorization process on your behalf; however, you are responsible for making sure it gets done. If you are unsure about whether a procedure or medication requires prior authorization, call the Humana Customer Care team at 855-273-0021 (TTY: 711).

How can I find out if my medications are covered under the plan?

The formulary is the list of drugs covered by the Humana Group Medicare Prescription Drug Plan. The plan formulary includes four tiers: Tier 1 — Generic or Preferred Generic; Tier 2 — Preferred Brand; Tier 3 — Non-Preferred; and Tier 4 — Specialty. To view the formulary, visit the Humana Board of Pensions website.

Are mental health services covered?

Post-retirement medical coverage does not include access to the Employee Assistance Plan (EAP). However, the Humana Group Medicare Advantage PPO plan includes benefits for mental health services provided on an inpatient basis, as well as outpatient mental health services provided by a state-licensed psychiatrist or doctor, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, physician assistant, or other Medicare-qualified mental healthcare professional as allowed under applicable state laws. Plan copayments apply. For details, contact the Customer Care team at Humana.

Will I have coverage during international travel?

The Humana Group Medicare Advantage PPO and PDP plans include worldwide benefits for emergencies. If you have an emergency outside of the U.S. and its territories, you will be responsible for paying for the services rendered upfront. You must then submit a claim, including proof of payment, itemized bill, physician order (if applicable), and medical records, to Humana for reimbursement. For details, view the Evidence of Coverage (EOC) under Coverage and Documents on the Humana Board of Pensions website.

For 2026, you also have access to International SOS services when traveling abroad.

Do I have to use a dentist in the Humana Dental Medicare Network?

In-network dentists have agreed to provide covered services at contracted rates. If you use an in-network dentist, you cannot be billed for charges that exceed the negotiated fee schedule, but you will still be responsible for paying your coinsurance.

Out-of-network dentists have not agreed to provide services at contracted fees. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions, and the provider may bill you for any amount greater than the payment made by Humana.

Contact the Humana Customer Care team for more details and to locate a Humana Dental Medicare Network provider.

Is there a network I have to use for vision services?

EyeMed is the in-network provider for the routine vision benefit that is included with the Humana Group Medicare Advantage PPO plan. This benefit includes a routine vision exam with refraction (up to one per year) and a combined annual benefit for contact lenses and glasses (lenses and frames). Contact the Humana Customer Care team for more details and to locate an EyeMed provider.

Are hearing aids covered?

The Humana Group Medicare Advantage PPO plan covers one routine hearing exam per year as well as part of your cost for hearing aids, up to one per ear per year, prescribed by an audiologist. To receive this benefit, you must use a TruHearing provider. Contact the Humana Customer Care team for more details and to locate a TruHearing provider.

How do I get more details about what’s covered?

View the Evidence of Coverage (EOC) for current and future year information as available. The EOC gives you details about your Medicare and prescription drug coverage for the plan year. You can also view a copy on the Humana Board of Pensions website under Coverage and Documents.

For 2026, there are separate EOCs; one for medical and one for prescription drugs.

If you would like the EOC mailed to you, contact the Humana Customer Care team.

Will I receive explanation of benefits statements?

You will receive an explanation of benefits (EOB) statement if a claim is denied. All other claims will be listed on your SmartSummary from Humana. The SmartSummary is a personalized benefits statement you receive after each month you’ve had a claim processed. You can also log in to your MyHumana account and see your past SmartSummary statements anytime.

For 2026, there are separate SmartSummary statements for medical and prescription drug claims.

What is Go365 by Humana?

Go365 is a wellness program that rewards you for completing eligible healthy activities, like walking or getting your Annual Wellness Visit. You track the activities you complete to earn rewards that can be redeemed for gift cards from retailers like Albertsons, CVS, Home Depot, Petco, and Walmart. If you enroll in the Humana Group Medicare Advantage PPO plan, you are automatically enrolled for the Go365 wellness program, and can participate online at MyHumana.com or by filling out and mailing in paper forms. For details about the program and how to participate, contact the Customer Care team at Humana.

What resources are available to me if I choose not to enroll in the Humana Group Medicare Advantage PPO plan?

If you would like to explore other healthcare coverage options, consider assistance that your state may offer through the State Health Insurance Program (SHIP) to help you find Medigap plans similar to the Medicare Supplement Plan or other Medicare Advantage plans.