Humana Medicare Advantage PPO 2027

This is the second consecutive year Humana has pulled back. For 2026, it dropped from 48 states to 46, plus Washington, D.C., and reduced its footprint by a net 193 counties. The 2027 announcement goes further.

CMS assigns star ratings to contracts, not to individual plans. Most Humana PPO members across the country are enrolled under one national contract, and its rating is inherited by every plan sold beneath it regardless of what that plan is called locally.

A 3.5 is below the roughly 3.7-star national average, and a full star below Aetna’s equivalent PPO contract. It is not a failing score, but on the one measure Medicare provides for comparing plan quality, Humana’s PPO is not where you go if quality ratings are your deciding factor.

The rating story is worth understanding because it explains the plan cuts rather than being separate from them.

Star ratings drive bonus payments from CMS, which carriers use to fund the extra benefits that make Medicare Advantage attractive. When Humana’s largest contracts each lost a half-star, the share of members in 4-star-or-better plans fell from 94% to 25% to 20% across two rating cycles — and the bonus revenue attached to them fell with it.

That is the pressure behind the exits. Humana has told investors it expects a meaningfully higher share of members in 4-star-plus plans for 2027, which would ease the squeeze if it materializes.

Setting the news aside, the structure of the product is the same as any Medicare Advantage PPO, and it is worth being clear about what you are buying.

No referrals. You can book a specialist directly rather than routing through a primary care doctor first, which removes an appointment and a delay from every specialist visit.

Out-of-network care is covered. At a higher cost share, but genuinely covered — which matters if you travel, split the year between two states, or want a second opinion outside the network. An HMO generally covers out-of-network care only in an emergency.

Providers can still decline. Coverage does not obligate an out-of-network provider to accept your plan. Call the office and confirm before the appointment.

You pay for the flexibility twice. A modestly higher premium and a second spending ceiling that counts out-of-network care. The premium gap is small. The ceiling gap is not.

Every Medicare Advantage plan has a maximum out-of-pocket limit. Once you hit it, the plan pays 100% of covered services for the rest of the year. It is the number that answers “what is the worst this can cost me?”

An HMO has one. A PPO has two: an in-network limit, and a combined limit counting in-network and out-of-network spending together. CMS has finalized both ceilings for 2027.

Those are ceilings, not price tags. Carriers set each plan’s actual caps at or below them, and Humana’s enrollment-weighted average across all its plans was $5,951 for 2026 — the lowest of the three largest national carriers. That average is one of the genuinely strong things about this carrier.

One caveat before the numbers. Plan-level details for your county do not publish until October 1, 2026, and Humana’s CEO has said the company will adjust 2027 benefits as it works toward its margin target. Everything below reflects the 2026 plan year and should be read as history, not as a quote for 2027.

Humana has priced in the middle of the market and leaned on Part B giveback as its signature offer.

Read the out-of-pocket cap before the premium. A $5,951 average ceiling is the number that protects you in a bad year, and it is where Humana genuinely outperforms its larger competitors.

CMS finalized the 2027 Medicare Advantage and Part D rule on April 2, 2026. Carrier specifics are still moving, but the framework every Humana plan operates inside is already set. We break these figures down across every major carrier in our 2027 Medicare Advantage costs and benefits by carrier guide.

Two other changes matter for 2027.

September: read your Annual Notice of Change. This is the document that tells you whether your plan continues into 2027. Given the exits, it matters more this year than usual.

October 1: 2027 plan details publish. Premiums, networks, and caps for your county become public. You get two weeks to compare before enrollment opens — start with our overview of 2027 Medicare Advantage plans.

October 15 – December 7: Annual Enrollment Period. The main window. Anything you choose takes effect January 1, 2027.

If your plan is discontinued. You generally qualify for a Special Enrollment Period, which gives you more time and more options than the standard window. Do not simply accept the replacement you are assigned without comparing it.

➤  Is Humana cancelling Medicare Advantage plans in 2027?

Yes. In August 2026 Humana told investors it will exit plans covering roughly 600,000 members for the 2027 plan year, about 8% of its 7.2 million Medicare Advantage members, and that most affected plans carry star ratings of 3.5 or lower. Humana has not yet announced which specific plans or counties are affected — those details come with CMS bid approvals later in the year. It expects to move roughly 40% of affected members into its other plans.

➤  Is my Humana PPO plan being discontinued?

Nobody can tell you yet, because Humana has not published the list. What is known is that most exited plans rate 3.5 stars or lower, and Humana’s national individual PPO contract H5216 is rated 3.5. Your Annual Notice of Change, which arrives each September, is the document that confirms whether your specific plan continues into 2027.

➤  What happens if my Humana plan is discontinued?

You are not left without coverage. You generally qualify for a Special Enrollment Period, giving you more time and more options than the standard Annual Enrollment Period, and Humana will typically offer a replacement plan. That replacement may have a different network, different costs, and different spending caps, so compare it against alternatives rather than accepting it by default.

➤  What star rating do Humana PPO plans have?

Humana’s national individual PPO contract, H5216, is rated 3.5 out of 5 stars for 2026, below the roughly 3.7-star national average. Across all of Humana’s Medicare Advantage business, about 20% of members are in plans rated 4 stars or higher, down from 25% in 2025 and 94% in 2024. Humana runs regional contracts that score differently, so check the contract ID on your specific plan.

➤  What is the maximum a Humana PPO can cost me in 2027?

For 2027, CMS caps in-network out-of-pocket spending at $9,850 and combined in-network plus out-of-network spending at $14,800. Those are the highest limits any Medicare Advantage PPO is permitted to set, and most plans set theirs well below — Humana’s enrollment-weighted average was $5,951 for 2026, the lowest among the three largest national carriers. Prescription drug spending is capped separately at $2,400 in 2027.

➤  How much do Humana Medicare Advantage plans cost?

For the 2026 plan year, about 66% of Humana plans carried a $0 premium, and plans that charged one averaged $26.88 per month. 2027 pricing does not publish until October 1, 2026, and Humana’s CEO has said benefits will be adjusted for 2027, so treat those as historical figures. You also pay your Medicare Part B premium separately, though many Humana plans give part of it back.

➤  What is Humana’s Part B giveback?

It is a benefit on certain plans, including some PPOs, that reduces the Medicare Part B premium deducted from your Social Security payment. Humana’s Full Access Giveback PPO is built around it. The amount varies by plan and county, and not every plan offers it, so confirm the figure on the specific plan’s Summary of Benefits.

➤  How is a Humana PPO different from a Humana HMO?

A PPO covers out-of-network care at a higher cost share and generally does not require a referral to see a specialist. An HMO usually covers out-of-network care only in an emergency and often requires referrals, in exchange for lower costs. Across all 2026 Medicare Advantage enrollees, HMOs averaged a $12 monthly premium and a $4,636 in-network cap, against $18 and $6,592 for PPOs.

➤  Does a Humana PPO include prescription drug coverage?

Most do — roughly 90% of Humana Medicare Advantage plans included Part D coverage for 2026, and 99.2% of those put Tier 1 drugs at a $0 copay. If you choose a plan without drug coverage, make sure you have creditable coverage elsewhere or you may face a late enrollment penalty.

➤  When can I enroll in a Humana PPO for 2027?

The Annual Enrollment Period runs October 15 through December 7, 2026, with coverage starting January 1, 2027. Plan details publish October 1, giving you two weeks to compare first. If you are already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period from January 1 to March 31, 2027 gives you one additional switch. If your plan is discontinued, you generally qualify for a Special Enrollment Period.