Humana & Medicare Advantage

Medicare Advantage plans of all types must include everything that is covered under Original Medicare. These plans often include additional benefits or coverage on top of what you could get through Original Medicare. There are several types of plans available through Humana.

Health maintenance organization (HMO) plans are a common Medicare Advantage option for beneficiaries offered by Humana. If you choose to go with an HMO, remember that you will likely have to remain within the network of your plan. You may also need a referral from your primary care physician to receive care from a specialist.

Humana HMO plans come with some added financial security since they can have a maximum out-of-pocket cost for each year, ensuring that you’ll never have to spend over a certain amount even in a medical emergency.

You typically will have unlimited primary care physician visits and many plans also include an over-the-counter allowance for purchasing things like first aid kits. As with other Medicare Advantage options, these plans usually include coverage for vision, dental and hearing as well.

If you opt for a preferred provider organization (PPO) plan from Humana, you are not required to stay within a network to receive care. The trade-off is that your costs will likely be higher if you choose to do this.

Like with an HMO Plan, you should be able to receive vision, dental, hearing and prescription drug coverage as well as everything included in Original Medicare. You should also have access to annual screenings and added benefits like fitness programs and even emergency coverage outside the U.S.

A Humana private fee-for-service (PFFS) plan offers you the flexibility to go to any doctor if they participate in Medicare, instead of being limited to what is available through your specific plan. Your PFFS plan will determine how much you must pay after receiving treatment or service from a doctor.

Most Humana plans include prescription drug coverage, preventive screenings and hospitalization coverage. Like other plans, you also will have emergency coverage.

A special needs plan (SNP) is designed for people who have specific diseases or qualifying conditions and exists to offer them coverage and support those needs. SNPs can offer benefits catered to the specific conditions that they cover. These plans include everything covered under Part A and Part B as well as prescription drug coverage.

To qualify, you must be eligible for both Medicare and Medicaid, have a qualifying condition or live in a skilled nursing facility.

Humana may not offer the best plan for every individual’s specific needs. You should consult with your advisor to determine whether a Humana plan is the right fit for you.

The cost of your plan will depend on where you live, the number of plans available in your area and which type of plan you are purchasing. In 2023, 62% of Humana’s Medicare Advantage plans come with a premium of $0, helping to keep your Medicare Advantage plan costs down. You must still pay your Part B premium. Consolidated premiums, which include Part C and Part D coverage, range from $4 to $199 per month.

A Medicare advisor can help you compare plans among the various companies that sell Medicare Advantage plans.

As with most plans, there are both pros and cons to opting for Humana.

As far as cons go, while the insurance company itself is available all over the country, certain plans may not be. For example, SNPs are not available in every county and there may be limitations on the type of condition covered. You may also have to be dually enrolled in Medicaid to be eligible for some SNPs.

For the pros, one major advantage for Humana is its status as a national company with availability across the U.S. This can offer more security than you might get from a more regional option and ensures that some form of coverage is likely available where you live.

Another pro is that Humana’s customer satisfaction tends to be high. Forrester awarded Humana the top spot for customer satisfaction among health insurers in its comprehensive 2022 US Customer Experience Benchmark survey.

Humana typically has solid Medicare Star ratings. According to the company, 96% of its 2023 plans rate four stars or higher. Currently, more than three million members spread across 46 states and Puerto Rico are covered by contracts with a 4.5-star rating.

In addition, three of Humana’s plans were classified as High Performing Icons by the Centers for Medicare & Medicaid Services (CMS) in 2023.