How Does Humana Medicare Work?

By James O'Neal

Are you new to Medicare or shopping around for a new Medicare provider? Humana Medicare is one of the most well-known on the market.

It serves a variety of states across the nation, catering to different individuals’ unique needs. There are a lot of choices Humana offers for coverage so you can select which one is right for you.

How exactly does it work?

In this article, we’re going to cover the different types of plans offered and how Humana and Medicare differ. Let’s jump right in.

What Are the Different Types of Humana Medicare Plans?

Humana is a private insurance company that has a contract and partnership with Medicare. This means they can offer a variety of Medicare plans directly through Medicare. The catch is that it only transfers to the Medicare Advantage plans.

The types of procedures and appointments covered vary, but it includes prescriptions under Medicare Part D, as well as benefits that don’t fall under A or B.

HMO Humana Medicare Plan

If you select the HMO plan, you’re required to get care from doctors or physicians inside of the network. You can find providers that qualify by going to the Humana website. Choosing an in-network doctor allows your services coverage.

You’ll need to establish a primary care provider, so if you have a need for a specialist, they’ll be able to refer you. Emergency care may not always fall under this umbrella. HMOs keep the cost low for both you as the patient and the insurance company.

PPO Humana Medicare Plan

If you go with the PPO plan, you can get in-network and out-of-network care. The difference is that you’ll receive better coverage for in-network care versus out-of-network.

For out-of-network care, you’ll be paying more out of pocket, so it’s still better to choose providers that are in your network first. You won’t have to get physician’s approval or a referral to make an appointment with a specialist. While HMOs keep the cost relatively low, PPOs cost quite a bit more.

PFFS Plan

A Private Fee-for-Service (PFFS) plan has their own infrastructure for payments and patient cost. PFFS provides a large range of plans, but the health care provider has to agree to their terms and conditions. If the medical center or physician doesn’t agree to their terms, they’re not able to be used.

PFFS plans are pretty flexible, more so than other Humana Medicare plans.

Are Medicare and Humana Comparable?

Humana Medicare is a service, but are Humana and Medicare the same? Humana is a health insurance company, like Anthem Blue Cross or other health insurance. They are a private company that happens to provide Medicare.

Medicare is simply one of the plans they offer, alongside their other health care plans. They administer Medicare Part D and other Advantage plans. They are able to do this because the federal government set up a contract with them.

A Brief History of Medicare

What exactly is Medicare? It’s been around for over 50 years and was put into place by President Johnson. The goal of its implementation is to help individuals over 65 and those with disabilities receive the health care they need.

The CMS (Center for Medicare and Medicaid Services) owns the Medicare program. The Medicare program is comprised of different sections and parts for different types of insurance coverage.

Let’s take a look at the different segments of Medicare and see what’s covered under those sections.

Medicare Part A

Medicare Part A covers hospitalization or in-patient care. This includes nursing facilities and nursing home care as well as hospice and home health. If your provider thinks that Medicare won’t cover a certain part of a procedure or something you need to be covered, you’ll need to sign an agreement stating you understand.

Medicare Part B

Medicare Part B includes coverage for doctor visits and out-patient care. This includes supplies or services needed to treat or diagnose medical conditions. It also includes any preventative services. Preventative services won’t cost you anything.

Part B also covers your mental health, any durable medical equipment you may need, ambulatory services, and clinical research and trials. It doesn’t provide as much coverage as Medicare Part D, but Humana Medicare Part B covers some outpatient prescriptions.

Medicare Part C

Medicare Part C covers Medicare Advantage plans. This program is actually contracted out to insurance providers like Humana to implement and manage. The rules and standards that these insurance providers must follow are set up by the CMS.

Humana Medicare Part C provides all of your coverage for both parts A and B. There may be other benefits as well such as dental or vision coverage. Medicare Part C follows the in-network plan where patients are required to see doctors and hospitals within their network.

Medicare Part D

Medicare Part D includes coverage for prescription drugs. Like Medicare Part C, this program is run by outside insurance providers or private firms.

Medicare associates different drugs with different tiers. The tiers all have varying costs associated with them. Higher tiers will be more expensive whereas the lower tier drugs are more affordable.

If your physician or doctor believes you need to be prescribed a higher tier drug, you can file for an exception. An exception can sometimes grant you with a lower co-payment amount for higher tiered drugs.

With Humana Medicare Part D, outpatient prescription drugs are either covered partially or in full. Humana and Medicare split the cost of the payment of your prescriptions.

Consider Humana Medicare

As you can see, Humana has a solid partnership with Medicare and will continue to provide their plans for patients.

If you’re looking for a Medicare provider and want to go through an insurance company, Humana offers great benefits and guidance through their network of healthcare professionals.

If you’re interested in learning more about Medicare and how you can get signed up today, please contact us.