Medicare Plans Offered by Humana9 minute read

9 minute read

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Updated for May, 2019

At the age of 65, you may be eligible for medical insurance through a Medicare plan. You may also be eligible if you’re under 65 but have certain medical conditions.

Either way, you have two options for obtaining Medicare coverage. You can either purchase it directly from the federal government (this is known as Original Medicare) or you can buy it from a private insurance company (referred to as Medicare Advantage).

Medicare Plans Offered by Humana

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

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.

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