Humana 2024 MAPD Dental Benefits

As your new Humana Members start to use their benefits, one question that agents are asking is how members can find a dentist and the specific procedures that are covered under the Mandatory Supplemental Benefits (MSBs) for dental.  This attachment is the 2024 Humana Dental and Vision FAQ.  This is for agents only so please do not provide to members or prospects.  This document refers to MSBs and OSBs.  In The South Florida area, they only have MSB Dental and Vision benefits in our MAPD plans.  Please ignore the OSB (Optional Supplemental Benefits) unless you are selling in other states.  

Humana has great website that you and your members can visit at www.humana.com/sb.  Make sure to go to the Members and Agents section.  This site gives you links to the below resources (see the circled sections below in red.

• The Dental Code Sheets for all Humana MSB Dental Benefits
• The link to search for providers
• Reference information for members on PPO MAPD plans that wish to use an out-of-network provider and need to file for reimbursement – note that members on HMO MAPD Plans must use network providers 

The below information is to further explain when members can go out-of-network for the Dental Mandatory Supplemental Benefits.  Out-of-Network coverage only applies to PPO MAPD plans, members on a Humana MAPD HMO plan must use network providers for the dental benefits.  Members must go to in-network providers on HMO plans with the dental allowance as any Humana Gold Plus plan with Dental Allowance will not cover any out-of-network services.  You should always reference the Evidence of Coverage/Summary of Benefits as well for specific details on any plan.  You can access all of Humana’s Plan Documents in your Vantage Portal at www.humana.com through the Sales Enablement Library link.  

Out-of-network dental benefits 
If an MA dental plan has out-of-network benefits, there is always a possibility for balanced billing, as described in the Summary of Benefits:
“Out-of-network dentists have not agreed to provide services at contracted fees. Benefits received out-of-network are subject to any in-network benefits maximums, limitations, and/or exclusions. You may be billed by the out-of-network provider for any amount greater than the payment made by Humana to the provider.”

As a reminder, Humana’s dental network in Florida for 2024 for the MAPD Plans is the Florida Gold Plus Dental Network .  Members do not get a separate card to use for the dental benefits that are included in their MAPD Plans.  Remind your members to look at the back of the card to locate which dental benefits they have as part of their MAPD plan.  This is what the member should show their dental provider when getting services.  In this attachment, you can share with new members to assist them in making their dental appointments.  Humana also recommends members use the language below when making an appointment or visiting their dentist….

“My dental benefits are included in my Humana Medicare Advantage plan and are not considered separate dental insurance. These benefits are provided by dentists in the Florida Gold Plus Dental Network.”

Agents and members can utilize the Find A Doctor Tool at www.humana.com or agents can access the tool in their Vantage Portal.  Find the Florida GoldPlus Dental Network.  Pick the dental option, select All Dental Networks, and then from the drop down you will see the correct network.