One of the main advantages of going with a Medicare Advantage Plan is, unlike Original Medicare, this type of plan enables you to buy a policy that covers prescriptions, dental, and vision—in addition to medical and hospital coverage—all in one plan.
One such private insurance company is Humana, which has a variety of Medicare plans available. Some fall under Medicare Advantage, whereas others address prescriptions only or are designed to provide supplemental insurance needs. Let’s look at each one now
Medicare Advantage Plans Available Through Humana
At this time, Humana offers four different types of Medicare Advantage Plans. They are:
Humana Gold Plus HMO
With an Health Maintenance Organization (HMO) plan, you are required to name a primary care physician who participates in the plan’s network. This medical professional is responsible for your overall care and can refer you to specialists or other providers (who are also in the network) if your medical condition warrants it.
Some people prefer these types of plans because they usually have lower premiums and lower out-of-pocket expenses.
Humana Choice PPO
Under a Preferred Provider Organization (PPO) plan, you can see any doctor or specialist you’d like. Also, unlike with an HMO, you do not have to obtain a referral first. That makes this option preferable to those who like to choose their own healthcare providers.
Typically, PPOs cost more than HMOs, but you can help limit your out-of-pocket costs by choosing medical professionals in Humana’s network. Plus, many of the PPO plans offer free annual preventive screenings, which saves money related to these types of tests.
Humana Gold Choice PFFS
Humana also offers Private Fee-for-Service (PFFS) plans that enable you to see almost any doctor who is Medicare approved. The only requirement is that the medical professional you accept agrees to Humana’s Medicare Advantage PFFS Terms and Conditions of Payment.
These terms and conditions include agreeing to provide services covered by the plan that are deemed “medically necessary,” and being willing to accept payment in amounts dictated by Original Medicare.
Under a PFFS plan with Humana, the amount paid to healthcare providers and your portion of the costs are both determined by the plan you choose. Additionally, annual preventive screenings are generally covered in full.
Humana SNPs
The fourth type of Medicare plan offered by Humana is a Special Needs Plan (SNP). If you have a chronic condition—such as diabetes, cardiovascular or lung disorder, heart failure, or end-stage renal disease—or you’re eligible to receive Medicare and Medicaid, you may qualify for this type of plan.
Humana SNPs are only available in certain states, so location-related restrictions do apply. For instance, if you have a chronic condition, you can only obtain an SNP in the states of Colorado, Florida, Illinois, Indiana, Kentucky, Louisiana, Nevada, Ohio, South Carolina, Texas, and Virginia.
However, if you qualify for this type of plan due to being eligible to receive both Medicare and Medicaid (also known as a Dual Eligible Special Needs Plan), you must live in Alabama, California, Florida, Georgia, Indiana, Kentucky, Louisiana, Maine, Montana, Mississippi, Missouri, North Carolina, Nebraska, New York, Ohio, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Texas, or Washington to sign up.
In addition to providing medical, dental, vision, and hearing coverage, many SNPs provide benefits related to non-emergency medical transportation, fitness program membership, an allowance for over-the-counter medications, and more.
Additional Humana Benefits
When you purchase a Medicare Advantage Plan through Humana, you’re entitled to a few additional benefits free of charge.
If you prefer to exercise outdoors, their FLEX program can potentially connect you with other Humana members who engage in physical activity at local parks or recreation centers.
One is the HumanaFirst Nurse Advice Line. You can call this phone number (800-622-9529; TTY 711) 24 hours a day, 7 days a week to speak with a registered nurse about health concerns related to a particular medical condition (illness or injury-related). You can also call if you’d like more information about Humana’s other healthcare resources.
You also have the option of receiving your prescription drugs directly in your mailbox via Humana Pharmacy mail delivery. This is helpful when it is difficult to make it to a pharmacy because of mobility issues, a lack of transportation, or an extended distance between you and the pharmacy. This can also potentially save you money as scripts received through the mail typically have lower copays than those filled at an in-store pharmacy.
To sign up for delivery, you just need to provide your prescription information online or ask your doctor to submit the script on your behalf. He or she can do this electronically using ePrescribe, by calling it in to 800-379-0092, or by faxing it to 800-379-7617. Once Humana receives it, a pharmacist double checks the medication to ensure that it’s right for your particular medical condition, the script is filled. Then, another pharmacist verifies it has been filled per the doctor’s orders, and if it passes all of these tests, it is then shipped to you in plain packaging to protect your privacy.
This entire process takes between 7 and 10 days for new prescriptions and 5 to 7 days for refills. If it is a specialty medication you need, the pharmacy will call you directly so you know what date the medicine will be delivered and to ensure that you understand how to take it correctly.
Humana Medicare Advantage participants also have access to its SilverSneakers Fitness Program, which entitles you to work out at any one of 14,000+ fitness centers nationwide. If you prefer to exercise outdoors, their FLEX program can potentially connect you with other Humana members who engage in physical activity at local parks or recreation centers.
Some Humana Medicare plans also include Go365, a fitness program that enables you to earn points based on your level of participation in physical activities. You can redeem the points for rewards such as movie tickets, gift cards, and fitness devices.
Humana Prescription Drug Coverage Options
Many Medicare Advantage Plans typically provide some level of prescription drug coverage, and Humana offers three stand-alone Medicare prescription drug plans (commonly referred to as Medicare Part D) if that is the only type of coverage you need. They are:
Humana Walmart Rx Plan
This prescription drug plan offers lower costs if you fill your scripts at one of the 5,200+ Walmart or Sam’s Club pharmacies nationwide. They can be filled at other pharmacies, but at a higher cost. The premiums can be as low as $22.20 per month. Many also have $0 deductibles for Tier 1 or 2 medicines (the generic brands) and copays as low as $1 for certain generic drugs.
Humana Preferred Rx Plan
Under this plan, you can use most any pharmacy you’d like to fill your prescriptions, even via mail delivery if that’s what you prefer. Copays are as low as $0 for generic drugs if you use a Humana Pharmacy, and premiums range from $22.50 to $41.70 per month with a $415 annual deductible.
Humana Enhanced
If you’d like a prescription drug plan with no deductibles (regardless of which Tier your drug is on), Humana Enhanced is an option to consider. Copays are as low as $0 for mail delivery and $5 for in-network pharmacies, but they can go as high as $116 for Tier 3 brand-name drugs. If you have a Tier 4 or 5 drug, coinsurance costs range from 33 percent to 50 percent depending on the tier and whether you receive your prescription via mail or in person at a pharmacy (mail scripts are typically cheaper).
Prescription Drug Plan Considerations
If you have multiple medications due to your health condition(s), Humana’s Medication Therapy Management Program may become an option. This program entitles you to a one-on-one review with a pharmacist or other healthcare provider to ensure that you’re getting the most from all of your prescription medications.
If you have multiple medications due to your health condition(s), Humana’s Medication Therapy Management Program may become an option.
This review involves the pharmacist going over your scripts and making sure the medications are working as intended, are as affordable as they can be based on your specific prescription drug plan, and are safe for you to take. They’re also there to answer any questions you may have.
To qualify for the Medication Therapy Management Program, participants must meet all three of these requirements:
- Have at least three of the following conditions: chronic heart failure, osteoporosis, diabetes, abnormal cholesterol, and/or chronic obstructive pulmonary disease
- Take eight or more chronic maintenance drugs
- Have medication costs likely to exceed $4,044 in 2019
Humana warns that prescription drug coverage obtained under Medicare Part D has what is known as a “donut hole.” This refers to the gap that exists after drug coverage limits have been reached but before catastrophic coverage kicks in. During this gap, participants are often forced to pay more for their regular prescription medications.
While this “donut hole” has been problematic for Medicare recipients for years, Humana says that this gap will close in 2019. The AARP adds that this gap was originally supposed to close in 2020, but a budget deal signed by the president will speed it up a year. This move will require certain drug manufacturers to pay 70 percent for brand name prescriptions during this gap period as opposed to only covering 50 percent like they have previously.
Humana’s Medicare Supplement Insurance Plans
Even if you have Medicare parts A and B, there are still some healthcare-related costs that aren’t covered including copayments, coinsurance, and deductibles. To help offset some of these expenses, you may choose to purchase a Medicare Supplement Insurance Plan, also known as Medigap.
You must:
- Be 65 years of age or if you’re under 65, have a qualifying disability or end-stage renal disease
- Be enrolled in Medicare parts A and B
- Live in the state covered by the supplemental policy
There are a number of Medicare Supplement Insurance Plans offered by Humana and they range from Plan A to Plan N, each providing benefits for various copayments and coinsurances.
For instance, Medicare Supplement Insurance Plan A provides benefits related to Medicare Part A coinsurance and coverage, Medicare Part B coinsurance and copayments, blood, and hospice care coinsurance and copayment.
Medicare Supplement Insurance Plan G provides these same benefits plus benefits related to skilled nursing facility coinsurance, Medicare Part A deductibles, Medicare Part B excess charges, and foreign travel emergencies.
Generally speaking, Medicare Supplement Insurance Plans do not cover costs related to vision, dental, or hearing aids. They also don’t typically provide benefits related to long-term care, private-duty nursing, or prescription drug coverage.
Finding the Humana Medicare Plan for You
To find the Humana Medicare Plans available in your area, you can do an online search on their website.
Simply enter your zip code and you’ll be presented with a list of options in your geographical area. Deductibles, copays, maximum out of pocket costs, and monthly premiums are provided for each.
Humana’s website also lets you compare the three plans you’re most interested in purchasing in an easy-to-read chart.
If you prefer to talk to someone instead or if you have questions on one of the plans, you can contact Humana by phone at (866) 560-3122 (TTY:711). Sales agents are available between 5 a.m. and 8 p.m., seven days a week.
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