- Humana is a private insurance company that offers Medicare Advantage (Part C) plans.
- Humana offers HMO, PPO, PFFS, and SNP plan options.
- Not all Humana Medicare Advantage plans may be available in your area.
If you’ve already made the decision to go with a Medicare Advantage (Medicare Part C) plan, you still have some decisions to make. One of these is the insurance provider that will supply your coverage.
Humana is a for-profit health insurance company based in Kentucky and is approved by Medicare to sell Part C plans. We’ll talk about the plans Humana offers, their costs, what they cover, and more.
Health Maintenance Organization (HMO) plans are attractive to many people because of their affordability. In many ZIP codes, there are plans available for $0 monthly premium.
Low-cost copays will be required when you see providers, such as specialists. These fees vary, based upon location, but range from about $0 to $50 in most locations. In many instances, your primary care physician will not require a copay.
Annual deductibles for Humana HMO plans vary from $0 to around $800, based on your location and the plan you choose.
There may be an annual deductible for prescription drug coverage as well. These vary from $0 to about $445, based on your location and the plan you choose.
Your annual maximum out-of-pocket costs will also vary based on the plan you choose, but the max for any Medicare Advantage plan is $7,550 in 2021.
Required by law, these plans cover at least as much as original Medicare, so you can be assured of getting hospitalization coverage, medical coverage, and preventive care, including annual screening appointments and vaccines.
As with any HMO, you are required to choose your doctors, including your primary care physician (PCP), from within the plan’s provider network. Humana offers a Point-of-Service (HMO-POS) plan that lets you choose out-of-network providers in certain circumstances.
You will need referrals from your PCP to see specialists and other providers.
Humana’s HMOs cover emergency medical care outside of the United States.
Some of Humana’s HMOs also include prescription drug coverage that is equal to or better than stand-alone Medicare Part D plans.
Most of these plans include free membership to many local gyms and health clubs. Not every fitness facility is included on this list.
Preferred Provider Organization (PPO) plans give you the freedom to choose any Medicare-approved doctor you wish to see. However, out-of-plan providers will cost more in most instances.
Your monthly plan premiums and copays may be higher than HMOs in some ZIP codes but are still affordable. Copays for specialists range from $20 to $40 in most instances.
Most annual preventive screenings can be obtained at no cost.
Again, your annual maximum out-of-pocket costs will also vary based on the plan you choose but cannot exceed $7,550.
As required by law, these plans cover at least as much as original Medicare, so you can be assured of getting hospitalization and outpatient medical coverage.
You will not need a referral to see a specialist.
These plans provide in-network home health care. They also offer optional add-ons, such as vision, dental, prescription drug coverage, and fitness programs.
Emergency care outside of the United States is another added benefit.
Private fee for service (PFFS) plans are not available everywhere.
With a PFFS plan, you can see any Medicare-approved doctor, provided that they have accepted Humana’s PFFS terms of service and conditions of payment.
Humana PFFS plans differ from original Medicare and from other supplement plans. As the insurer, Humana, not Medicare, will determine what they pay healthcare providers and hospitals as well as how much you are required to pay for your care.
With a PFFS plan, you do not have to choose a primary care physician. You also will not require a referral to see a specialist.
Most annual preventive screenings can be obtained at no cost.
It is very important to confirm that your doctor has an ongoing agreement with the Humana PFFS network prior to receiving services. Unless you require emergency services, you will not be guaranteed that the doctor you see will treat you or accept payment from your plan.
Your costs may vary based on the plan you choose. You will most likely pay the cost-sharing expenses determined by your plan, such as set copayments and coinsurance. You may also be required to pay a provider’s bill in addition to these set fees.
By law, these plans cover at least as much as original Medicare, so you can be sure you’ll get hospital and outpatient medical services.
Prescription drug coverage is included in most, but not all, PFFS plans.
Emergency care outside of the United States is covered.
Since non-network doctors can choose to accept payment through a PFFS plan based on the service provided or on a case-by-case basis, you cannot be sure that a doctor will treat you, even if they have treated another patient who has the same PFFS plan that you do.
Special Needs Plans (SNPs) are typically free and require no copays, premiums, or coinsurance.
SNPs are only available if you meet specific criteria, such as:
- living in specific types of inpatient settings, such as a nursing home
- having a disabling chronic condition that is approved by Medicare for an SNP
- eligibility for both Medicare and Medicaid
Humana offers two types of SNPs that are available in approximately 20 states. One type is for people who qualify for both Medicaid and Medicare. The other type is for those who have certain chronic health conditions, such as:
- cardiovascular disease
- chronic heart disease
- chronic lung disease
- end stage renal disease (ESRD)
If you qualify for a Humana SNP, you will get all of the benefits of original Medicare plus Medicare Part D.
Health and wellness programs may also be included for conditions such as diabetes and for preventive care. Your SNP may also cover routine dental care, vision care, hearing care, and nonemergency medical transportation services. An over-the-counter (OTC) allowance is usually included for a set amount.
Medicare Advantage (Part C) plans are plans that offer additional coverage over what original Medicare provides. The costs for each plan varies based on the level of coverage you opt in for, as well as your geographic location.
Medicare Advantage plans must legally cover at least as much as original Medicare. The additional services they offer typically include dental coverage, vision, hearing, and prescription drugs.
Not all types of plans are available in every county. Medicare’s find a plan tool can help you review Medicare plans available in your area. You will need to enter your ZIP code.
Humana offers a wide range of Medicare Advantage plans throughout most of the country. These plans are required by law to provide at least as much coverage as original Medicare.
Most plans offer more types of coverage, such as vision, dental, and prescription drugs. The plan you are able to choose must service your ZIP code. Costs vary by plan.
This article was updated on November 13, 2020, to reflect 2021 Medicare information.
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