About Humana Coverage in Duncansville
Humana operates 30 distinct plans in Duncansville, PA, with a combined in-network roster of 71 doctors across 18 medical specialties. Among the five largest insurers we track in Duncansville, Humana ranks #5 by provider count, the leader is Aetna with 172 in-network doctors. Use this page to confirm a specific provider is in-network, understand which Humana plans have the widest reach in Duncansville, and compare coverage against other major insurers before scheduling care.
Humana sells PPO, PFFS, HMO, SNP plan types in Duncansville. A PPO (Preferred Provider Organization) lets you see any provider without a referral; out-of-network care is covered but you pay a higher share. An HMO (Health Maintenance Organization) requires you to pick a primary-care doctor and get referrals for most specialist care, usually in exchange for lower premiums. An EPO (Exclusive Provider Organization) is in-network only, like an HMO, but skips the referral requirement. A POS (Point of Service) plan blends HMO-style in-network with PPO-style out-of-network options. Your plan name is on your member ID card.
Humana is a Medicare Advantage carrier in Duncansville with 12 plans available to seniors, listed below with star ratings and premiums. Humana does not currently sell ACA marketplace plans in PA; commercial coverage shown above comes through employer groups.
Data is sourced from the federally-mandated CMS Transparency in Coverage filings that every insurer must publish monthly. Medicare Advantage plans come from the CMS MA Landscape File. Last refreshed June 28, 2026. Networks change between filings, so even when a doctor appears here we recommend calling their office with your member ID to confirm current network status before your visit.
Plan Type Mix in Duncansville
Humana organizes its Duncansville network into several plan types, each with different rules about which doctors you can see and what referrals you need. The bars below show the unique-provider share of the 71-doctor network that offers plans of each type.
A high PPO share means most Humana doctors in Duncansville accept the insurer’s broader preferred-provider plans. these give you maximum choice and don’t require referrals to specialists. A high HMO share signals a tighter gatekeeper model: lower premiums but you usually need your primary-care doctor to refer you before a specialist will bill. EPO and POS bars sit between those two on both flexibility and cost.
Because individual doctors typically participate in multiple Humana plan types at once, these percentages don’t sum to 100%. the same provider can appear as both PPO and OAP coverage. What the chart tells you is which plan categories have meaningful depth in Duncansville.
Percentages don’t sum to 100% because most doctors participate in several plan types simultaneously.
Humana Plans in Duncansville
Humana contracts with doctors at the network level in Duncansville. Each network below is a contract; your specific plan (printed on your member ID) maps to one of them.
Medicare PPO/Employer PPO Plus
PPO
65
HumanaGoldChoice Ntwk PFFS
PFFS
64
Medicare PPO
PPO
64
Natl Medicare HMO/SNP-Travel
HMO
60
Gold Plus HMO PA
HMO
48
Gold Plus Dual Eligible SNP
SNP
45
National Employer HMO-Home
HMO
9
EyeMed
7
Natl Med HMO H6622 (VA)-Home
HMO
3
Gold Plus HMO
HMO
2
Gold Plus HMO- New Jersey
HMO
2
Humana Healthy Horizons in OH
1
Humana Medicare Advantage Plans in Duncansville
12 Humana Medicare Advantage plans available to seniors in Duncansville. Each plan combines Medicare Parts A, B and usually D (prescription drugs) into one product, with star ratings and monthly premiums shown.
Star ratings (1-5) reflect overall plan quality measured by CMS. a 4-star plan generally indicates above-average member experience and care coordination. Premiums shown are the monthly cost on top of the standard Medicare Part B premium.
Source: CMS Medicare Advantage Landscape File. Star ratings reflect overall plan performance per CMS quality measures. Premiums shown are monthly Part C+D consolidated.
Top Specialties Accepting Humana
Humana’s Duncansville network spans 18 distinct medical specialties. The mix reflects where the insurer has negotiated the deepest physician contracts. primary-care specialties and behavioral health tend to dominate, with surgical and sub-specialty networks typically narrower.
Click any specialty below to see a filtered list of just those in-network providers in Duncansville, including ratings, locations, years of experience, and contact information. For specialties with fewer than 10 in-network providers, you’ll likely want to check nearby cities too. the section further down on this page has your geographic options.
Physician Experience in Humana’s Duncansville Network
Years since medical school graduation is a reasonable proxy for experience, though it doesn’t capture fellowship training, subspecialty certifications, or years spent in specific clinical settings. For Humana’s Duncansville network the breakdown below gives a quick sense of whether you’re picking from a predominantly early-career roster or one weighted toward veteran practitioners.
A network heavy on early-career doctors (0–5 years) often means lower wait times for new patients and exposure to the latest training, while veteran providers (30+ years) typically bring deeper pattern recognition for unusual presentations. A balanced distribution. roughly one-quarter in each bucket. is a healthy signal that the insurer has depth at every career stage, not just new graduates filling out its directory.
Telehealth Coverage in Duncansville
3 of 71 Humana in-network providers (4%) offer telehealth visits in Duncansville. Video appointments are typically covered for follow-ups, medication refills and adjustments, mental-health sessions, dermatology triage, and low-acuity primary care.
Availability and reimbursement still vary by state regulation and specific plan. Psychiatry, behavioral-health, and primary-care telehealth is near-universal at this point; procedural specialties (cardiology, orthopedics) typically offer video visits for pre-op consults and post-op follow-up but not initial diagnostic visits. Call the office with your Humana member ID to confirm your plan covers the visit type you need.
Top specialties offering telehealth in Duncansville
Top Hospitals Serving Humana Patients in Duncansville
Hospitals with the most Humana-network physicians practicing there. Large affiliation counts indicate that Humana has a durable relationship with the facility, which typically means smoother prior-authorizations for admissions, lab work, and follow-up care coordinated under one roof.
Hospital coverage is a separate contract from physician coverage. your Humana plan may cover a doctor who admits at Hospital X but classify the hospital itself as out-of-network, leaving you with a surprise facility bill. Before scheduling anything inpatient or procedural, call both the doctor’s office and the hospital billing line with your member ID to confirm both sides are in-network for the specific plan you hold.
Coverage Compared in Duncansville
Side-by-side provider counts for the five largest commercial and government insurers tracked in Duncansville. These numbers show raw network breadth. they don’t adjust for quality, specialty mix, or your specific plan’s tier structure, but they’re a useful first filter when choosing a carrier at open enrollment.
If Humana’s provider count looks limited for your needs, the alternatives below may fit better. Click any row to open that insurer’s Duncansville provider list with the same filters, plan breakdown, and hospital affiliations that you’re seeing here.
Nearby Cities with Humana Coverage
Cities closest to Duncansville where Humana has an in-network provider base of meaningful size. Useful if you’re willing to drive a short distance for a hard-to-find specialist, have two offices to choose between, or are planning a move inside the region.
The mileage figures are straight-line distances computed from average practice-address coordinates, not drive-time. Counts reflect each nearby city’s Humana network size. a small count doesn’t mean no coverage, just that your in-Duncansville options are likely more plentiful.
Frequently Asked Questions
Common questions about Humana coverage in Duncansville
How do I find an Humana in-network doctor in Duncansville, PA?
Humana has 71 in-network providers across 18 medical specialties in Duncansville. This list is compiled from federally-mandated CMS Transparency in Coverage filings, last verified June 28, 2026. Filter by specialty, plan type, gender, telehealth or experience above to narrow your search, then click any provider for full credentials and contact details. Always confirm coverage with your specific plan before scheduling.
What Humana plan types are available in Duncansville?
Humana sells 4 distinct plan types in Duncansville: PPO (66 doctors), PFFS (64 doctors), HMO (61 doctors), SNP (45 doctors). PPO plans give you the broadest provider choice without referrals; HMO plans require a primary-care referral but typically have lower premiums; EPO plans skip the referral but stay in-network only; POS plans blend HMO in-network rules with PPO out-of-network options. Choose by reading what's printed on your member ID card and matching it to one of the rows in the Plans section above.
Does Humana offer Medicare Advantage in Duncansville?
Yes. Humana offers 12 Medicare Advantage plans in Duncansville for 2026, with plan types including PPO, Regional PPO, PPO D-SNP, PFFS. The average CMS star rating across these plans is 3.5 of 5. Medicare Advantage (Part C) bundles Parts A and B with usually Part D prescription drug coverage, often adding dental, vision, and wellness benefits. Enrollment is open during the annual election period each fall.
What's the highest-rated Humana Medicare Advantage plan in Duncansville?
HumanaChoice Giveback H5216-116 (PPO) (PPO) holds Humana's top CMS star rating in Duncansville at 3.5 of 5. Star ratings reflect overall plan quality based on member experience, customer service, drug pricing, and clinical care measures. Plans rated 4 or higher generally indicate above-average performance.
Are there $0 premium Humana Medicare Advantage plans in Duncansville?
Yes. 4 of Humana's 12 Medicare Advantage plans in Duncansville carry a $0 monthly premium for 2026. Note that $0 premium plans still require you to pay the standard Medicare Part B premium each month, plus copays and deductibles when you use care. Compare each plan's MOOP (maximum out-of-pocket) limit to understand worst-case annual cost.
Which hospitals in Duncansville accept Humana?
Hospitals where Humana doctors most commonly practice in Duncansville include UPMC ALTOONA, CONEMAUGH NASON MEDICAL CENTER, UPMC BEDFORD MEMORIAL, PENN HIGHLANDS TYRONE. This is inferred from physician affiliations rather than direct insurer-hospital contracts, so confirm hospital network status separately with both your Humana plan and the hospital's billing department before scheduling any inpatient or surgical procedure. Even when a doctor is in-network, the hospital where they admit may not be.
Which medical specialties have the most Humana providers in Duncansville?
Humana's Duncansville network is largest in Family Practice (22), Orthopedic Surgery (11), Nurse Practitioner (7). Primary care, behavioral health, and physical therapy tend to dominate insurer networks because high patient volumes drive deeper provider contracts. Surgical sub-specialties typically have narrower networks. Click any specialty in the section above to see a filtered list of those in-network providers.
How does Humana compare to other insurers in Duncansville?
Humana ranks #5 of 5 major insurers tracked in Duncansville by provider count, with 71 doctors. Aetna leads at 172 providers. Larger network size means more provider choice but doesn't guarantee that your specific doctor is in-network with any insurer. The Coverage Compared section above shows side-by-side counts for the top five carriers in Duncansville.
How do I verify a doctor is in-network with Humana?
Three steps: first match the doctor's name against this list, second call the provider's office with your member ID to confirm they currently accept your specific Humana plan, and third check Humana's own member portal for the most authoritative real-time status. Networks change between monthly federal filings; our data was last refreshed June 28, 2026.
What if my doctor isn't listed here?
This list reflects Humana's submitted network data as of the last federal filing on June 28, 2026. Doctors join and leave networks between filings, so a current in-network provider may be missing if they joined recently. Call the doctor's office to ask whether they currently accept Humana, then check Humana's own member portal for confirmation.
When was this Humana data last updated?
The Humana Duncansville provider list was last refreshed June 28, 2026. Doctor and network data come from the federally-mandated CMS Transparency in Coverage filings that every insurer must publish monthly. Medicare Advantage plans come from the CMS MA Landscape File. Refresh cadence: monthly for provider data, annually for marketplace and Medicare plans.
Related healthcare resources
Patient resources for Duncansville Humana members.
Common health topics
Common medications
Common procedure costs
Data freshness
Last verified June 28, 2026 · Source: CMS Transparency in Coverage federal filings · Refresh cadence: monthly