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Humana Health Insurance (Complete Guide)

Humana Health Insurance (Complete Guide) | Very Good Coverage

What is Humana Health Insurance? What kind of health services and Medicare advantage plans do they provide?

Humana is a health insurance company that provides Medicare plans in all the USA's 50 states. It is the top Medicare provider in the US in terms of availability. Humana Medicare services are accessible in more than 84% of US counties. This figure is more than any other private health insurer.

Humana has various types of Medicare Advantage plans as well as stand alone prescription drug plans. The company's aim is to provide at least one affordable plan to every Medicare beneficiary. Humana also has special and low-income plans to support Medicare and Medicaid eligible individuals.

Information provided in this guide is found from online sources that were cross checked to be valid with Humana’s services and operations.

US Medicare Services

A lot of people get health insurance through various coverages like spousal and employer. However, the older you become, the more important it is that you pay attention to your Medicare because you will need better health insurance coverage and you can only get then with Medicare. You do not have to be a Medicare beneficiary before you understand what it is all about.

Medicare is a health insurance scheme enacted by the federal government of the US. It is usually eligible for only seniors that are 65 years old or more, or those below 65 years old that live with disabilities.

Many people tend to confuse Medicare with Medicaid. But Medicaid is different from Medicare in that its health insurance is for only low-income US citizens. Unlike Medicare, you do not have to be a retiree before benefiting from Medicaid.

Medicare is of four various parts namely:

  • Part A and B Medicare
  • Part C Medicare
  • Part D Medicare

Part A and B Medicare are also known as original Medicare and the government, through social security benefits, will provide coverage for every aspect of this Medicare through Humana health insurance or any other private insurer you opt for.

Part C Medicare is known as Medicare Advantage, and Part D Medicare is known as Prediction Drug Plans. Both parts of Medicare are not covered by the government. They are provided by private insurers like Humana.

Original Medicare is the same regardless of who your insurer is. But while Medicare Advantage and prescription drug plans are similar to most insurers, the disparities are in the benefits and features of the plans that the private insurance company provides.

Aside from these types of Medicare, there are also Medicare Supplemental Plans covered by private companies to help limit spontaneous expenses that could be financially depressing.

Original Medicare

Original Medicare is the bedrock of Medicare. It consists of Part A Medicare known as hospital insurance and Part B Medicare, known as Medical insurance.

Part A Medicare will take care of all hospital costs that have to do with surgery or sickness. The services it will cover include the following:

  • Cost of a Semi-private room used in the hospital
  • Cost of services in a skilled nursing home.
  • Cost of health care received at home
  • Hospices care.
  • Cost of about 3 pints of blood when a transfusion is necessary.
  • Meals cost in the hospital
  • Every other medical service received under inpatient hospital care.

Part B Medicare will be in charge of Outpatient costs. Any expense that arises from a doctor’s visit will be under Part B Medicare. It does not matter if it is your private doctor or a health specialist.

Part B Medicare will cover the following:

  • Cost of X-rays and imaging
  • Transportation cost incurred through Ambulance rides.
  • LAISK diagnosis and testing.
  • Cost of preventive health care services

Part B Medicare will cover medical costs, even if the services were in a hospital. As long as the Medicare beneficiary is not receiving inpatient care, it remains a Part B Medicare. For clarification health, preventative services like mammograms are not done in a doctor’s office but Part B Medicare will cover it, as long as it is not inpatient care.

Payment for Original Medicare

Because the original Medicare scheme is overseen by the social security administration does not mean that there won’t be some out-of-pocket services. Most Medicare beneficiaries will not have to pay any type of monthly premium for Part A Medicare but this is not the same for Part B Medicare.

Since Part B Medicare deals with medical insurance, you will be required to pay a monthly premium. The price for this is not the same with everyone because monthly premiums are determined by total annual income.

How to Sign Up for Original Medicare

There are 2 ways of signing up for Original Medicare in the US. The first way is for those that are retired and already receiving social security benefits. The Social Security department will automatically enroll them, and there will be no need to sign up.

Those that are not social security beneficiaries cannot be automatically signed up for Medicare. In this case, they will have to sign up for Part A and B Medicare via the local Security Administration. To go about this, visit your local social security office.

Enrollment for Medicare cannot be done randomly. There are enrollment periods and you will not be allowed to sign up for original Medicare outside these periods.

The most important period is the Initial Enrollment Period. This period refers to a seven months opening where you can enroll for Medicare, and you must be at least 65 years old. This period begins three months prior to your 65th birthday and will expire at the end of the three months after your birthday.

During this enrollment period, you can sign up for either or both Part A and B Medicare. Most people choose only plan A Medicare because they have existing employer health insurance or and insurance via their spouse’s employer. Choosing only part A insurance will save them the cost of Part B monthly premiums.

Signing up for any part of the original Medicare in the future will attract a fine for late enrollment.

Another window for Original Medicare Advantage is known as the General Enrollment Window and this is within the first day of the year and the last day of the month of March. The coverage for this will take effect in July.

You will be allowed to change your Medicare plans during an annual open enrollment period. This is always between the 15th of October and the 7th of December every year. Any change you make in this period will begin to take effect on the first of January the following year.

The changes you can make in the open enrollment period include switching from your original Medicare plan to a Medicare advantage plan or a prescription drug plan, etc.

Humana Medicare Advantage

Humana Medicare Advantage plans have a lot of benefits and features for your wellness. The plans also come with rules and costs for every member. Humana Medicare Advantage Plans will also cover drug prescription costs and members with such plans can visit any pharmacy in Humana’s network for their drugs. Humana has one of the best-rated mail order pharmacy services today, in the USA.

Some of Humana Health insurance Medicare Advantage plans include the following:

HMO Plans

Humana’s HMO plan will not limit you to any private care provider, and you can even keep on using your own provider if you like. However, in case you need to see a specialist that will be provided by Humana, they will need a referral from your private care provider. You also have the option of moving to any private care provider under Humana’s network.

Humana HMO Medical Advantage Plan will cover the cost of your original Medicare as well, and it will also include other enticements for your Part A and B Medicare. Other benefits of this plan include prescription drug coverage and Silver Sneakers fitness.

PPO Plans

With this Humana medical advantage plan, you will not need a referral to visit a specialist even though your primary health care or the medical expert is not under the Humana network. However, visiting a specialist outside the Humana network will most likely incur more cost than using one of Humana's providers.

The benefits of PPO will also be different based on the region of the US that you are in. However, some of the major benefits will include home service care, prescription drug cost, fitness and wellbeing benefits, nutritional benefits, dental, vision, and hearing care benefits. This pan will also provide coverage out of the country, so it is perfect for those that are always on the go.

Private Fee for Service Plan

This medical advantage plan does not require that you own a personal care provider to obtain referrals to visit a specialist. What Humana does with this plan is that they came up with a network of some of the best health care providers in the US, and members of this plan will be able to get the healthcare services they need from this network.

However, this plan is location-dependent because Humana will not give a provider network in some parts of the country. The only advantage to this is that members will be able to access any healthcare provider that offers Medicare services. Some of the best benefits of this plan are that it covers a lot of annual preventive diagnosis, hospitalization costs, emergency healthcare, and the cost of drug prescriptions.

Prescription Drug Plan

This is also known as Part D and it is a strictly standalone plan for those who do not want to incur extra costs on drug prescription. Humana drug plans will cater to the cost of any prescription or drug medication under the Medicare coverage gap. However, the plan only concerns drugs and will not cover any other medical issue.

You can enroll for this plan alone with either or both of your Medicare advantage plans. Although the benefits of these plans are under some of Humana’s Medicare Advantage plans, signing up for just the Drug Prescription Plan will cost less.

Humana has three types of prescription drug plans and they include the following:

The Humana Walmart Value RX Plan

This is Humana’s Part D plan with the least monthly premium and copayments cost for drugs that are regarded as tier 1 and 2. However, with this plan, you will have to pay deductibles for drugs that are of higher tiers.

Humana Premier Rx Plan

This is the most all-inclusive Plan D you can enroll for with Humana. The number of drug prescriptions that it covers is about 3700 drugs. However, the plan has more expensive monthly premiums than other prescription drug plans.

Humana Basic RX Plan

Humana designs these plans specifically for those in need of extra help. It is a form of Medicare drug prescription plan for people with limited income, and they will get their prescription free of charge at the least cost possible.

Medicare Supplement Plan

Medicare Supplement plan is also known as Medigap, and its main purpose is to provide coverage for some of the original Medicare costs like copayments, coinsurance, monthly premiums, and deductibles.

Humana has 10 Medicare supplement plans that provide coverage for various costs. However, these plans are location-based and not all of them are available in every region of the country.

It is also important for you to know that Medicare Supplement plans cannot be combined with Medicare Advantage plans or Prescription Drug Plans.

Humana Medicare Supplement Plans include the following:

Supplement A

This plan will provide coverage for both Part A and B Medicare costs such as copayments and coinsurance.

Supplement B

This plan will provide coverage for copayments and coinsurance in Part B, alongside deductibles in Part A

Supplement C

This plan will cover the cost of deductibles, coinsurances, and skilled nursing services in Part A and B Medicare. It will also cover 80% of foreign travel emergency costs.

Supplement F

This Plan will cover Medicare supplements in Medicare Advantage as well as all out of pocket charges in Part B Medicare

Supplement G

This plan will cover coinsurance in Part A and B, deductibles in Part A, out-of-pocket charges in Part B, skilled nurse care services, and 80% of foreign travel costs.

Supplement K

This plan will cover all Part A coinsurance, hospice, deductibles, and copayments. It will also cover Part B coinsurance and copayments and finally settle all fees for skilled nurse facility charges.

Supplement L

This plan will cover Part A coinsurance, copayments, hospice, and deductible, as well as Part B coinsurance and copayments. It will also settle the fees for skilled nurse care in Part A.

Supplement N

This plan will settle the costs of Part A and B coinsurance, Part A skilled nurse care fee, deductibles, and 80% of foreign emergencies.

Humana Special Need Plans for Medical Advantage

Humana has two special need plans under its Medicare Advantage plans. They are the dual-eligible special need plans and chronic condition special need plans.

The chronic condition plan is for those with a minimum of one chronic health issue such as chronic cardiac failure diabetes, chronic lung disorder, etc.

Humana special needs Medicare advantage plans are for beneficiaries that qualify for both Medicare and Medicaid under the federal government rules.

Both types of special needs advantages that Humana offers provides eligible members with all the benefits and features of the ordinary Plan C Medicare advantage. They will also include some particular benefits for the members involved.

Members of Humana special needs Medicare advantage will get some services and support tailored for their own condition. This will include any form of specific support for members of a certain health issue.

Humana special needs plans will provide a regular examination for vision, hearing, and dental care. They will also include benefits for transportations that are non-emergency, fitness and wellbeing schedules, and over-the-counter purchase. Humana special needs plans usually require zero or very little payments.

Limited Income Newly Eligible Transition

This is a Medicare service that will give drug prescription coverage to Medicare-eligible individuals that qualify for the low-income Medicare subsidy. Another name for this program is Extra Help. People that qualify for either supplemental security income, or Medicaid and Medicare will be able to benefit from this program.

Medicare members that cannot afford a Prescription Drug Plan will be able to take advantage of this plan temporarily until they can do so. Humana Health insurance joined this Medicare program in 2010.

Humana Medicare Advantage Extra Benefits

Most Medicare Advantage Plans you can find for today will provide costs on benefits such as hearing, vision, dental, fitness, foods, store purchases, drug prescription, etc. These benefits help Medicare-eligible individuals meet as many of their health needs as possible at zero or low cost.

Humana Medicare advantage plans will provide benefits such as dental and vision care, medication purchases done over the counter, wellbeing and fitness programs, and home food delivery after an inpatient stay. All these benefits are also available for the Dual Eligible Special Need Plans.

The latest Drug prescription plan Humana Medicare offers does not require any copayment for Telehealth, emergency care, and even outpatient mental health. There is also no copayment required for treating and testing COVID.

Any Humana health insurance Medicare Advantage member that tests positive to COVID 19 will get the necessary home kits and in addition, 2 weeks’ meals delivered at home for the duration of the quarantine period.

For more benefits, Humana provides Insulin Saving for their Medical Advantage prescription drug members and those with any of the Part D standalone plans. With this, program-specific diabetes prescription drugs will cost $35 for a month's supply.

Members of Humana plans can also benefit from their wellness benefits that include:

  • Rewarding members for taking part in health improvement routines via the Go365 program.
  • Various fitness benefits such as gym and workout with SilverSneakers
  • Provision of meal cards for members of the Dual eligible Medicare advantage special need, so that they can purchase nourishing meals and beverages.
  • Meal delivery for members going through a post-surgery stage just coming out of inpatient care, or those that are living with a chronic health complication.
  • People living with chronic health issues will receive adequate care management from Humana, such that their condition will be managed optimally. Some members of the Medicare advantage plans will be eligible to receive home services from humans. This will be overseen by a personal care manager whose job is to provide help for dependent members at home.

Customer Services

Humana customer care is reachable via a phone line and you may also request an online appointment. You can reach out to the customer service between 8 am and 8 pm EST every day, including weekends. There are different phone numbers available for ordinary members, new members, and special need plan members.

If you are an existing or prospective member, the customer care will be able to provide you with important information for you to make monthly premiums payments online. Existing members will also be able to communicate with Humana customer service via the Humana app known as Humana.

This app is available on Android and iPhone smartphones. It provides members with features to access their plan coverage, plan features and benefits, check their ID card, verify claims, and find any health care provider and pharmacy under the Humana Health Insurance network.

Humana will also provide answers and respond to basic inquiries via the Twitter platform. This will be available from 6 am to 8 pm every day, including weekends. For confidentiality, Humana will not respond to any private health inquiry on Twitter or any social media platform

Humana Services Ratings

Some of the most notable insurance companies rating and how Humana is faring include the following:

NAIC

Any online complaints against Insurers are being tracked by the National Association of Insurance Commissioners. This is to make sure that Insurance companies are kept on their toes.

The index used to measure these complaints will mean any company with less than a rating of 1 got fewer complaints than expected and a rating of more than one means that the company received more complaints than expected.

In 2019, the NAIC rated Humans as 1, and following the previous year's ratings of 2.17 and 3.61 in 2018 and 2017 respectively, this was a huge improvement for the company.

AM Best

This is a credit rating organization that evaluates the financial capability of insurance companies, including those in health insurance like Humana. The latest rating in 2019 was an A- for Humana health insurance, and this implies that the company has a great financial ability to offset its current insurance obligations. The A- according to AM Best ratings means Excellent.

NCQA

National Committee for Quality Assurance is an organization that provides ratings and accreditation for health provider companies based on the quality of service they offer and how they satisfy their customers.

In its latest rating for 2020, Humana got a score between the range of 2 and 4, out of a total of 5. The score rating was a measure of how customers are satisfied with their services in terms of customer’s access to the needed care, their satisfaction with doctors, and the Humana health plan they enroll for.

A lot of Humana plans were rated 4 of a possible 5 for how satisfied the customers are.

J.D Power

JD power focuses on Medical Advantage studies in the US, and measures various Medicare advantages plans. From the overall rating index of 1000, Humana health insurance got a score of 806 that places its Medical advantage plans as the third-best in the nation. Humana’s score of 806 is above the average score of Medicare advantage plans in the country that is 800.

Medicare Rating

US Medicare and Medicaid also evaluate the services that private insurers provide for medical advantage and prescription drug plans. The criteria for this rating are based on the ability of a provider to keep its members healthy and how they deal with critical cases like chronic conditions. They also consider the ratings of existing members of the plan and the customer service provided by the company. Complaints from the members will also take effect on the rating.

Medicare ratings are also based on the performance of the plan in states, counties, and regions. For their latest rating in 2020, members of Humana medical advantage plans rated the services 4 stars out of 5.

Medicare Insurance Services Cost

Humana Medicare plans costs are dependent on various determiners like the type of coverage you want, the state you live in, and the private insurer you choose.

The most advisable way to find the best plan for you in the location you live is by checking Medicare’s website and clicking on "plan finder".

On Humana’s website, you can also compare their various Medicare advantage options. The stand alone prescription drug plans and every other related cost.

A lot of people are always particular about monthly premium costs. However, many Medicare Advantage plans will cover the cost of these premiums. In 2020 about 60% of those that enrolled for the Medicare Advantage PDP plans did not have to pay a monthly premium cost.

Estimation of all monthly premiums paid in 2020, including those with costs places the figure at just $21.

However, in terms of Medicare advantage costs, it is important to know that monthly premium costs do not tell the whole story. Regardless of if Medicare advantage cost covers a prescription drug plan or not, they can still settle costs like copayments, deductibles, and coinsurance. On a broader view, these costs may even be less expensive than what you might be able to save out of the Medicare Plan with no monthly premium cost.

Humana Medicare Advantage PDP Costs

Humana’s charges for Medicare Advantage plans include the following;

Medicare advantage PDP cost

HMO Plan

The cost for this ranges from $0 to $130. The monthly average cost is $11.72

PPO Plan

The cost for this ranges from $0 to $201. The monthly average is $30.98

Private Fee for Service Plan

The cost for this ranges from $0 to $145. The monthly average is $60.08

Medicare Advantage PDP Deductibles

HMO Plan

The cost for this ranges from $0 to 445. The monthly average is 104.59

PPO Plan

The cost for this ranges from $0 to $445. The monthly average is $230.64

Humana Prescription Drug Plan Costs

The charges for Humana standalone PDP plans include:

Walmart Value Rx Plan

This is the PDP plan with the least monthly premium cost of $17.2, and it does not have any deductible on Tier 1 and 2 drugs. But there are copayments of $1 and $4of prescriptions for Tier 1 and 2 drugs in any Humana preferred pharmacy. In pharmacies that are not under Humana’s network, the copayments are $10 and $20 for the Tier 1 and 2 drugs respectively. There are no copayments for Tier 3 to 5 drugs but the cost of their deductibles and coinsurance is $445.

Premier Rx Plan

The cost range for this PDP plan is from $58.30 to $72.50 based on the location you reside. Here, there are no deductibles for Tier 1 and 2 drugs, while Tiers 3 to 5 will have a deductible cost of $445.

For copayments, the costs are $1 and $4 for Tiers 1, in pharmacies under Humana’s network. For pharmacies outside the network, the costs are $5 and $10 respectively. Also, there are no mail-in order copayments for Tier 1 and 2 drugs. Copayment is higher for Tier 3 drugs while coinsurance is higher for Tier 4 and 5 drugs.

Basic Rx Plan

This plan is designed for low-income owners that qualify through Extra Help. The idea with this plan is to make prescription cost at their most available for Low-income earners. Monthly premiums in this plan are between the price range of 419.7 to $45, based on the location you reside. Copayment for Tier 1 drugs comes at zero cost while Tier 2 drugs have $1 copayment. However, for pharmacies that are not in Humana’s network, Tier 1 and 2 drugs will cost $1 and $2 respectively. There are no coinsurance costs for Tier 1 and 2, neither are their mail-in orders for them. For Tier 3 to 5, there are coinsurance costs.

Advantages of Using Humana Medicare Plans

Here is an overview of what you stand to gain from choosing Humana as your Medicare provider service:

  • Large Network: Humana has one of the largest providers, pharmacies, and specialist base in the USA
  • Large Outreach: Humana Medicare Advantage Plans are accessible in more counties than any other private insurer in the US. Also, at least one plan is present in every US state.
  • COVID 19: A lot of private health insurers have removed copayment costs for testing COVID 19, but Humana removes copayments for both testing and treatment of the virus.
  • Customer Satisfaction: 92% of Humana’s Medicare Advantage members rated their plans 4 stars out of 5 with the US Medicare evaluation.

About THE AUTHOR

Greg McKnight

Read more about Greg McKnight

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