• Humana is a private insurance company that offers Medicare Advantage plans.
  • Humana offers HMO, PPO, PFFS, and SNP Advantage plans.
  • All Humana Advantage plans may not be available in your area.

If you’ve already made the decision to go with a Medicare Advantage plan (Medicare Part C), you still have some decisions to make. One of these is the provider you will choose. The other is the type of Advantage plan that will be best for you.

Humana is an American company, based in Kentucky. They are one of many for-profit health insurance companies that are approved by Medicare to sell Medicare Advantage plans. They sell four types:

  • HMO: health maintenance organization plans
  • PPO: preferred provider organization plans
  • PFFS: private fee for service plans
  • SNP: special needs plans

Not all types of plans are available in every county. Medicare’s Find a Medicare plan tool can help you review Medicare plans available in your area. You will need to enter your zip code.

This article will go into depth about Humana’s Advantage (Part C) plans.

Medicare Advantage 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 every Medicare Advantage plan is available everywhere. Your county and zip code will determine to a large part what plans you may purchase.

There are four types of Advantage plans offered by Humana. They include:

Humana Medicare Advantage HMO plans

Cost

Humana HMO plans are attractive to many people because of their affordability. In many zip code areas, 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 average $30 in most locations. In many instances, your primary care physician will not require a copay.

Annual deductibles for each HMO plan vary from $0 to around $400, based on your location and the plan you choose.

There may be an annual deductible for prescription drug coverage. These vary from $0 to $400, based on your location and the plan you choose.

Your annual maximum out of pocket costs will also vary based upon the plan you choose, but average around $3,000-$4,500.

Coverage

Required by law, these plans cover at least as much as original Medicare, so you can be assured of getting hospitalization coverage, immunizations for conditions such as the flu, and preventive care, including annual screening appointments.

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 which 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 U.S.

Some of Humana’s HMOs also include prescription drug coverage that is equal to or better than Medicare Part D.

Most of these plans include free membership to many local gyms and health clubs. Not every fitness facility is included on this list. This benefit is called the SilverSneakers® fitness program.

Humana Medicare Advantage PPO plans

Cost

Humana 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 code areas but are still affordable. Monthly premiums tend to range from $0-$200, or more. Copays for specialists range from $20-$40, in most instances.

Most annual preventive screenings can be obtained at no cost.

Your annual maximum out-of-pocket costs will also vary based upon the plan you choose, but average around $3,000-$7,000.

Coverage

As required by law, these plans cover at least as much as original Medicare, so you can be assured of getting hospitalization 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 U.S. is covered.

Humana Medicare Advantage PFFS plans

Cost

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 in order to see a specialist.

Most annual preventive screenings can be obtained at no cost.

It is very important to confirm that the 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 upon 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.

Coverage

By law, these plans cover at least as much as original Medicare, so you can be assured of getting hospitalization coverage.

Prescription drug coverage is included in most, but not all, PFFS plans.

Emergency care outside of the U.S. 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 assured that a doctor will treat you, even if they have treated another patient who has the same PFFS plan that you do.

Humana Medicare Advantage SNP plans

Cost

SNP plans are typically free and require no copays, premiums, or coinsurance.

Special needs plans are only available to people who meet specific criteria, such as:

  • living in specific types of institutionalized settings, such as a nursing home
  • having a severe or disabling chronic condition that is approved by Medicare for this purpose
  • eligibility for both Medicare and Medicaid

Humana has two types of SNP plans that are available in approximately 20 states. One type is for people who qualify for aid through Medicaid as well as Medicare, and one type is for people who have certain chronic conditions, such as:

Coverage

If you qualify for a Humana SNP plan, 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 plan may also cover routine dental care, vision care, hearing care, and non-emergency transportation services. An over-the-counter (OTC) allowance is usually included for a set amount.

You must enroll in original Medicare before you can get a Medicare Advantage plan. You must also live in the area that the plan services.

People with end stage renal disease are not usually eligible for Medicare Part C.

Deadline typeDates or period of time
Initial enrollment The 7-month period that starts 3 months before your 65th birthday and ends 3 months after that date
General enrollmentJanuary 1 – March 31 each year
After general enrollmentIf you enroll in traditional Medicare (parts A & B) during General enrollment, you have a 3 month window (between April 1 – June 30) to enroll in a Part D drug plan or switch to an Advantage plan.
Special enrollmentAny time after you are eligible for Medicare that you lose your current health coverage. Special enrollment periods last for 8 months after the date of the special event.
Open enrollmentOctober 15 – December 7 each year
Plan change enrollmentOctober 15 – December 7 each year after your initial enrollment

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.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

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