Humana is a private insurance company that administers Medicaid plans, but it is not Medicaid itself

Humana is a for-profit health insurance company that contracts with state Medicaid programs to manage coverage for Medicaid members. If you have a Humana Medicaid plan, your coverage is still Medicaid — the state program pays Humana to handle your claims, customer service, and provider network. You are not paying Humana directly; the state is.

This matters because it changes who you contact with problems. If your Medicaid coverage is through Humana, you call Humana's customer service line for questions about your plan, not your state Medicaid office. But your underlying coverage and income limits are still set by your state's Medicaid program, not by Humana.

Humana operates Medicaid plans in multiple states, but not all states use Humana, and not all Medicaid members in a state that uses Humana are enrolled with Humana. Your state may contract with Humana, UnitedHealthcare, Molina, Centene, or other companies — or it may manage Medicaid directly without a private contractor.

Key Takeaways

  • Humana is a private company hired by your state to run Medicaid coverage, so you have Medicaid benefits but you contact Humana for plan questions.
  • Your Medicaid income limits, covered services, and may be able to access rules come from your state, not from Humana.
  • You can find out whether you are enrolled with Humana by checking your Medicaid card, calling your state Medicaid office, or logging into your state's Medicaid portal.
  • If Humana denies a claim or service, you can appeal to Humana first, then to your state Medicaid office if you disagree with Humana's decision.

How to check if your Medicaid plan is run by Humana

The fastest way is to look at your Medicaid card. Most cards print the plan name and company name on the front. If it says "Humana" or "Humana Medicaid" anywhere on the card, your plan is with Humana. Some cards also print a customer service number; if it is a Humana number, that confirms it.

If you do not have your card or it is unclear, call your state Medicaid office directly. They can tell you which company manages your coverage in seconds. You can find your state Medicaid office number on your state's health department website or by calling 211.

You can also log into your state's Medicaid portal or member website. Most states have an online system where you can see your coverage details, including the name of your managed care plan. Search "[your state] Medicaid login" or "[your state] Medicaid portal" to find it.

What changes if your Medicaid is through Humana

Your coverage itself does not change — you still have Medicaid, and the same services are covered. What changes is the company you contact and the network of doctors you can see. Humana maintains its own list of in-network providers, and using an in-network doctor usually costs you less or nothing. Using an out-of-network provider may cost more or may not be covered at all.

When you need a referral or prior approval for a service, you request it from Humana, not from your state Medicaid office. Humana decides whether to approve it based on your plan's rules, though your state Medicaid office can override Humana's decision if you appeal and win.

Your copayments, deductibles, and out-of-pocket limits are set by Humana's plan design, within the limits your state allows. Medicaid plans typically have low or zero copayments, but the exact amount depends on the specific plan and your state.

Finding doctors and services in the Humana Medicaid network

Humana publishes a provider directory on its website and in a printed book you can request. You can search by doctor name, specialty, or location. The directory shows which doctors are in-network for your specific Humana Medicaid plan, because Humana may run multiple plans in your state with different networks.

Call Humana's customer service number on your Medicaid card to ask whether a specific doctor is in-network. Have the doctor's name and location ready. Humana can also help you find a primary care doctor if you do not have one, because most Medicaid managed care plans require you to choose a primary care doctor.

If your regular doctor is not in Humana's network, ask whether Humana will make an exception and cover visits out-of-network. Some plans allow this for continuity of care, especially if you were seeing the doctor before you enrolled with Humana. The request usually takes one to two weeks.

What to do if Humana denies a claim or service

First, contact Humana and ask why the claim or service was denied. The denial letter should explain the reason and tell you how to appeal. Most denials are for one of three reasons: the service is not covered under your plan, you did not get prior approval when it was required, or the provider submitted the claim incorrectly.

If the reason is a mistake — for example, the provider coded the claim wrong or Humana did not receive your prior approval request — ask Humana to reprocess the claim. This often takes five to ten business days. If the reason is that the service is not covered, you can appeal to Humana in writing, explaining why you believe the service should be covered.

If Humana upholds the denial after your appeal, you can file a second appeal with your state Medicaid office. Your state can override Humana's decision if it determines that the service is covered under your state's Medicaid rules. This process usually takes 30 to 60 days. Ask Humana or your state Medicaid office for the appeal form and instructions.

Switching away from Humana Medicaid

If you are unhappy with Humana, you may be able to switch to a different Medicaid plan. This depends on your state's rules. Some states allow you to switch plans once a year during an open enrollment period. Other states allow you to switch if you have a good reason, such as your doctor leaving the network or repeated problems with claims.

Contact your state Medicaid office to ask whether you can switch plans and what the process is. If your state allows switching, you will usually choose a new plan through your state's Medicaid portal or by calling your state Medicaid office. The switch usually takes effect on the first day of the following month.

If you lose Medicaid coverage entirely — for example, because your income increased — you may be able to buy private insurance through the federal health insurance marketplace. You can also check whether you may have access to for a different program, such as subsidized marketplace coverage or your employer's health plan.

Frequently Asked Questions

Does Humana Medicaid cost money?

No. Medicaid is a state program that is free to members who meet income and other requirements. Humana does not charge you a premium, copayment, or enrollment fee. Your state pays Humana to manage your coverage. Some services may have small copayments (usually $1 to $5), but these are set by your state, not by Humana.

Can I use my Humana Medicaid card at any doctor?

You can use it at any doctor who accepts Medicaid, but you will have the best coverage and lowest cost if you use a doctor in Humana's network. Out-of-network doctors may not accept Humana Medicaid, or they may charge you more. Always call ahead to confirm the doctor accepts your plan.

What if I move to a different state?

Your Humana Medicaid coverage ends when you move. You will need to apply for Medicaid in your new state. The new state may or may not use Humana — it depends on that state's contracts. Contact your new state's Medicaid office to start the process, or call 211 for help.

How do I contact Humana if I have questions about my plan?

Call the customer service number on your Medicaid card. You can also visit Humana's website and log into your member account. Most Humana Medicaid plans have a 24-hour customer service line, and you do not need to pay for the call.

Can I have both Humana Medicaid and Medicare?

Yes. If you are 65 or older or have a disability, you may may have access to for both Medicare and Medicaid. This is called "dual coverage." Humana offers plans for dual-may be able to access members in some states. Contact Humana or your state Medicaid office to learn whether you may have access to and what plans are available.