At a glance
- 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.
- In 2020, Newsweek ranked Humana first place in customer service among all health insurance companies for the second year in a row.
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.
Humana HMO plans
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.
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.
Humana PPO plans
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.
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.
Humana PFFS plans
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.
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.
Humana offers three types of Part D prescription drug plans. These Part D plans are used to help manage the cost of prescription medications.
Humana Walmart Value Rx Plan
Under the Humana Walmart Value Rx Plan, Humana teams up with Walmart, Walmart Neighborhood Markets, and Sam’s Club pharmacies as its preferred cost-sharing partners.
This lets Humana offer additional prescription savings to people who purchase their medications at Walmart.
The Humana Walmart Value Rx Plan’s benefits include:
- $17.20 monthly plan premium nationwide
- $0 deductible on tier 1 and 2 medications
- $445 annual deductible on tiers 3 through 5 medications
- in-store copays as low as $1 on a 30-day supply of certain generic drugs at Walmart, Walmart Neighborhood Markets, and Sam’s Club
- copays as low as $3 on a 90-day supply of tier 1 preferred generics through Humana’s mail-delivery pharmacy
- more than 3,500 medications on the plan’s list of covered drugs
Before choosing the Humana Walmart Value Rx Plan, make sure you live near a Walmart location that features pharmacy services. While you are able to use other pharmacies under this plan, you won’t get additional discounts if you don’t use Humana’s preferred cost-sharing partners.
Humana Premier Rx Plan
Like the Walmart Value Rx Plan, the Humana Premier Rx plan also uses Walmart as its preferred cost-sharing partner. This means that living close to a Walmart location is key to saving the most on your prescriptions.
While this plan has a higher premium than the Walmart Value Rx Plan (from $58.30 to $72.50 per month, based on your state or region), the Humana Premier Rx Plan includes additional benefits:
- $0 deductible on tier 1 and 2 medications
- $0 copay on 90-day supplies of tier 1 and 2 medications from Humana’s mail-delivery pharmacy service
- preferred cost-sharing at Humana Pharmacy, Walmart, Walmart Neighborhood Markets, Sam’s Club, Publix, Kroger, Harris Teeter, HEB, and Costco pharmacies
- $445 annual deductible on tiers 3 through 5 medications nationwide and $305 in Puerto Rico
- more than 3,700 medications on the plan’s list of covered drugs
Humana Basic Rx Plan
Unlike Humana’s other Part D plans, the Humana Basic Rx Plan lets you pick your pharmacy, as long as it’s in the plan’s network.
Humana Basic Rx Plan premiums range from $19.70 to $45.00 per month, depending on your state or region. The plan’s annual deductible is $445.
The Humana Basic Rx Plan’s benefits include:
- $1 copay on a 30-day supply of tier 1 medications
- $4 copay on a 30-day supply of tier 2 medications after deductible at all in-network standard retail pharmacies
- preferred cost-sharing through Humana’s mail-delivery pharmacy with a $0 copay on a 90-day supply of tier 1 and 2 medications (after deductible)
Humana’s Medicare supplement insurance plans, also known as Medigap, can help you pay costs that Medicare parts A and B won’t cover. These costs include things like coinsurance, deductibles, and copayments.
Humana offers eight different Medigap plans:
The benefits for each Medigap plan from every insurance company are the same, with only some small differences.
What can be very different, however, is the company that you go with. This can affect the quality of service and the price of the plan.
Make sure to compare these offerings against competing insurance companies to get the best price and coverage for you.
Humana offers Medicare Advantage plans in 49 states. Medicare Advantage plans are not currently sold in Alaska.
Although there is wide availability throughout the country, specific types of plans and coverage options may only be offered in certain areas. This means that if your relative in another state has a Humana plan, the same plan might not be available to you.
As discussed above, each type of Humana Medicare Advantage plan comes with various extra services above what original Medicare offers. Here are a few of the coverage benefits many Humana plans offer:
Humana Medicare Advantage health plans vary by state and coverage. Some may include prescription drug plans while others may also incorporate additional services, such as dental, hearing, and vision.
You may search for available Humana Medicare Advantage plans using Medicare.gov’s plan finder tool. By entering your ZIP code and county, you will see available plans.
Here is a sample of the costs you’ll see with different Humana Medicare Advantage plans across the country in 2021:
|City/plan||Monthly premium||Health plan deductible||Drug plan deductible||Out-of-pocket max||Primary doctor visit||Specialist visit|
|Portland, OR: Humana Gold Plus H1036-153 (HMO)||$0||$0||$150||$5,700 in network||$0 copay||$35 copay|
|Flagstaff, AZ: Humana Honor (PPO)||$0||$0||doesn’t cover drugs||$4,400 in network; $6,700 in and out of network||$20 copay||$50 copay|
|Tulsa, OK: Humana Value Plus H6622-049 (HMO)||$19.60||$203||$445||$7,550 in network||20% coinsurance||20% coinsurance|
|Daytona Beach, FL: Humana Gold Choice H8145-061 (PFFS)||$101||$0||$200||$6,700 in and out of network||$5 copay||$40 copay|
|Brooklyn, NY: Humana Gold Plus SNP-DE H3533-031 (HMO D-SNP)||$21||$0||$200||$6,500 in network||$0||$40|
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.
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.