| HumanaChoice H5216-023 (PPO) | $0.00 | $55.00 | Not covered | Included |
| Humana Gold Plus H6622-037 (HMO) | $0.00 | $25.00 | $30.00 | $3000.00 |
| Humana Gold Plus H6622-036 (HMO) | $0.00 | $25.00 | $90.00 | $1000.00 |
| Humana Gold Choice H8145-052 (PFFS) | $0.00 | $45.00 | $100.00 | $1750.00 |
| Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) | $0.00 | $0.00 | $135.00 | $5,000.00 |
| Humana Gold Plus H6622-035 (HMO) | $0.00 | $35.00 | $30.00 | $2000.00 |
| Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) | $0.00 | $0.00 | $275.00 | $3500.00 |
| HumanaChoice H5525-005 (PPO) | $0.00 | $40.00 | $100.00 | $1000.00 |
| Humana Gold Plus H6622-054 (HMO) | $0.00 | $30.00 | $100.00 | $3000.00 |
| Humana Value Rx Plan (PDP) | Included | Included | Not covered | Not covered |
| Humana Premier Rx Plan (PDP) | Included | Included | Not covered | Not covered |
| Humana Basic Rx Plan (PDP) | Included | Included | Not covered | Not covered |
| HumanaChoice R0110-008 (Regional PPO) | $0.00 | $45.00 | Not covered | Included |
| HumanaChoice R0110-007 (Regional PPO) | $0.00 | $35.00 | Not covered | Included |
| Humana Gold Choice H8145-163 (PFFS) | $0.00 | $0.00 | Not covered | $1.00 |
| Humana Gold Choice H8145-055 (PFFS) | $0.00 | $30.00 | Not covered | $1.00 |
| HumanaChoice SNP-DE H7617-048 (PPO D-SNP) | $0.00 | $0.00 | $250.00 | $1000.00 |
| HumanaChoice H5525-086 (PPO) | $0.00 | $15.00 | $40.00 | $2,000.00 |
| HumanaChoice Giveback H5525-085 (PPO) | $0.00 | $45.00 | Not covered | Included |
| Humana USAA Honor Giveback with Rx (PPO) | $0.00 | $45.00 | Not covered | $3000.00 |
| HumanaChoice H5525-051 (PPO) | $0.00 | $25.00 | $25.00 | Included |
| HumanaChoice H5525-006 (PPO) | $0.00 | $40.00 | Not covered | $1000.00 |
| HumanaChoice SNP-DE H5216-227 (PPO D-SNP) | $0.00 | $0.00 | $125.00 | $1250.00 |
| Humana USAA Honor Giveback (PPO) | $0.00 | $40.00 | $100.00 | $1000.00 |
| HumanaChoice H5216-120 (PPO) | $0.00 | $30.00 | Not covered | $2000.00 |
| HumanaChoice Giveback H5216-116 (PPO) | $0.00 | $25.00 | $25.00 | $1000.00 |
| Humana Cleveland Clinic Preferred (HMO-POS) | $0.00 | $45.00 | $60.00 | $4000.00 |
| Humana Gold Plus H6622-013 (HMO-POS) | $0.00 | $40.00 | $75.00 | $2500.00 |
| Humana Gold Plus H6622-021 (HMO-POS) | $0.00 | $45.00 | Not covered | Included |
| HumanaChoice H5216-395 (PPO) | $0.00 | $55.00 | Not covered | $1000.00 |
| Humana Gold Choice H8145-032 (PFFS) | $0.00 | $40.00 | Not covered | $2000.00 |
| Humana Gold Plus H6622-014 (HMO-POS) | $0.00 | $35.00 | $140.00 | $3500.00 |
| HumanaChoice H5216-106 (PPO) | $0.00 | $50.00 | Not covered | $1500.00 |
| Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP) | $0.00 | $0.00 | $240.00 | $1500.00 |
| Humana Gold Plus H6622-055 (HMO) | $0.00 | $45.00 | Not covered | $1000.00 |
| Humana Gold Plus H6622-022 (HMO-POS) | $0.00 | $35.00 | $125.00 | $4000.00 |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | $0.00 | $30.00 | $35.00 | $1000.00 |
| Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) | $0.00 | $0.00 | $100.00 | $4000.00 |
| Humana Value Rx Plan (PDP) | Included | Included | Not covered | Not covered |
| Humana Premier Rx Plan (PDP) | Included | Included | Not covered | Not covered |
| Humana Basic Rx Plan (PDP) | Included | Included | Not covered | Not covered |
| HumanaChoice R0110-016 (Regional PPO) | $0.00 | $40.00 | Not covered | Included |
| HumanaChoice R0110-015 (Regional PPO) | $0 | $35.00 | Not covered | Included |
| Humana USAA Honor Giveback (PPO) | $0.00 | $45.00 | $50.00 | $2500.00 |
| Humana USAA Honor Giveback with Rx (PPO) | $0.00 | $45.00 | $50.00 | $3000.00 |
| HumanaChoice H7617-004 (PPO) | $0.00 | $40.00 | $75.00 | $1500.00 |
| HumanaChoice Giveback H7617-003 (PPO) | $0.00 | $40.00 | Not covered | $500.00 |
| Humana Dual Select H5525-046 (PPO D-SNP) | $15 | Included | $85.00 | $500.00 |
| Humana Full Access H5525-042 (PPO) | $0.00 | $55.00 | Not covered | $615.00 |
| Humana Value Plus H5525-041 (PPO) | $15 | Included | Not covered | $2000.00 |
| HumanaChoice H5525-030 (PPO) | $0.00 | $40.00 | Not covered | $1000.00 |
| Humana Together in Health Select (PPO I-SNP) | $0 | $0 | Not covered | Included |
| Humana Together in Health (PPO I-SNP) | $0 | $0 | Not covered | Included |
| HumanaChoice Giveback H5216-309 (PPO) | $0.00 | $40.00 | Not covered | $500.00 |
| Humana USAA Honor Giveback with Rx (PPO) | $0.00 | $45.00 | $50.00 | $3000.00 |
| HumanaChoice H5216-285 (PPO) | $0.00 | $40.00 | $75.00 | $1500.00 |
| Humana USAA Honor Giveback (PPO) | $0.00 | $45.00 | $150.00 | $3000.00 |
| HumanaChoice H5216-023 (PPO) | $0.00 | $55.00 | Not covered | $1000.00 |
| Humana Dual Select H7617-039 (PPO D-SNP) | $0 | $0.00 | $90.00 | $0 |
| HumanaChoice SNP-DE H7617-038 (PPO D-SNP) | $0 | $0 copay | $160.00 | $0 |
| Humana Value Choice H7617-032 (PPO) | $0 | $10 copay | $60 | $75 |
| Humana Full Access H7617-025 (PPO) | $0 | $10 copay | Not covered | $75 |
| Humana USAA Honor Giveback (PPO) | $0 | $45 copay | $50 | $75 |
| HumanaChoice H7617-016 (PPO) | $0 | $35 copay | Not covered | $1000 |
| Humana USAA Honor Giveback (PPO) | $0 | $40 copay | $50 | $75 |
| HumanaChoice H5216-131 (PPO) | $0 copay | $10 copay | Not covered | Not covered |
| HumanaChoice SNP-DE H5216-296 (PPO D-SNP) | $0 | $0 copay | $100.00 | $0 |
| HumanaChoice H5216-048 (PPO) | $0 copay | $35.00 | Not covered | $1000.00 |
| HumanaChoice Giveback H5216-430 (PPO) | $0 | $40 copay | Not covered | $75 |
| Humana Gold Plus H2486-003 (HMO) | $0 copay | $20 copay | Not covered | $1000 |
| Humana USAA Honor Giveback (PPO) | $0 | $45.00 | $50 | $1,500.00 |
| Humana Value Rx Plan (PDP) | Included | Included | Not covered | Not covered |
| Humana USAA Honor Giveback (PPO) | Included | $40 copay | Not covered | Not covered |
| Humana Premier Rx Plan (PDP) | Included | Included | Not covered | Not covered |
| Humana Basic Rx Plan (PDP) | Included | Included | Not covered | Not covered |
