2026 Benefit Information: Medicare Members
2026 Benefit Information: Medicare Members
As a Medicare-eligible member, you continue to have three plan options to choose from in 2026:
- Humana Medicare Advantage PPO & Prescription Drug Base Plans
- Humana Medicare Advantage PPO & Prescription Drug Enhanced Plans
- The 70/30 Plan, administered by Aetna
Open Enrollment ended October 31, 2025. Members needed to have taken action during Open Enrollment if they wanted to be enrolled in a different plan or needed to make any changes regarding dependents.
2026 Group Medicare Advantage Plan Resources
- 2026 Decision Guide
- 2026 Plan Comparison
- 2026 Plan Comparison - COBRA, Direct Bill & Sponsored Dependent Groups
- 2026 Summary of Benefits - Humana Base Plan
- 2026 Prescription Drug Summary of Benefits - Humana Base Plan
- 2026 Summary of Benefits - Humana Enhanced Plan
- 2026 Prescription Drug Summary of Benefits - Humana Enhanced Plan
- 2026 Evidence of Coverage (Medical) - Humana Base Plan
- 2026 Evidence of Coverage (Drug) - Humana Base Plan
- 2026 Evidence of Coverage (Medical) - Humana Enhanced Plan
- 2026 Evidence of Coverage (Drug) - Humana Enhanced Plan
- 2026 Annual Notice of Change (Base Plan)
- 2026 Annual Notice of Change (Enhanced Plan)
- 2026 Annual Notice of Change (PDP Base Plan)
- 2026 Annual Notice of Change (PDP Enhanced Plan)
- 2026 Comprehensive Formulary (Humana)
- 2026 Abbreviated Formulary (Humana)
- Humana Flyer for Providers
- 2026 Open Enrollment Medicare Outreach Webinar Presentation
- 2026 Open Enrollment Medicare Outreach Webinar Recording
- Step-by-Step Open Enrollment Instructions
- 2026 Humana Member Fact Sheet
- 2026 OE Medicare Member Telephone Town Hall Audio Recording
Humana Group Medicare (PPO) Plan Notes
- The Centers for Medicaid & Medicare Services (CMS) made policy changes for 2026 that impact Medicare Advantage Plans. These changes allow Humana to administer medical and pharmacy benefits separately. Splitting the medical and pharmacy benefit is managed by Humana, with members not experiencing a lot of change or noticeable differences.
- Splitting the medical and pharmacy benefit allows for significant savings to the State Health Plan.
- There is ONE SLIGHT CHANGE to the pharmacy benefit under BOTH Humana Medicare Prescription Drug Plans in 2026. The change is required by CMS and increases the Pharmacy out-of-pocket maximum from $2,000 to $2,100.
- Although the pharmacy benefit is separate from the medical benefit, you cannot elect to opt out of the pharmacy benefit.
- You’ll receive 2 NEW ID CARDS – one for medical, one for pharmacy. These cards will arrive separately in the mail.
- You’ll receive 2 CONFIRMATIONS OF ENROLLMENT –one for medical, one for pharmacy and some other duplicated CMS required notices.
- There may be changes to the Humana Medicare Prescription Drug Plan formulary (drug list), so members are encouraged to review that information when it becomes available.
The 70/30 Plan, administered by Aetna Notes
- There are INCREASES to the deductible and copays in this plan for 2026.
- For 2026, the Clear Pricing Project is ending and will not be available; however, the Plan will continue to offer lower copays for certain Preferred Providers. If you would like to change your selected Primary Care Provider (PCP) to a Preferred Provider, you will need to wait until after Jan. 1, 2026, to make that change.
- If your selected PCP is already noted as a Preferred Provider, you do not need to take any action. As a reminder, PCPs can be changed anytime, and ID cards typically arrive 7-10 days after the change is made.
- The formulary (drug list) for the 70/30 Plan is updated quarterly, so there is always a possibility that your medication could change tier levels or become a non-covered drug.
- Preferred and non-preferred insulin continues to have a $0 copay for a 30-day supply.
2026 70/30 Plan Resources
CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager.
The State Health Plan utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost.
These documents and tools include information based on the 2025 formulary and are subject to change prior to January 1, 2026.