Humana Medicare Advantage Plans

Humana Advantage Plans

Though there are many different healthcare providers that can offer selections for alternative Medicare coverage, such as through a Medicare advantage plan, you’ll do yourself a great favor considering some of your options more individually – take, for example, one of the more recognizable competitors, Humana. Humana aptly puts forward its new selection of advantage plans every year, each with a noticeable shade of difference separating itself from another plan, all while considering the certain benefits and rules most necessary to your own preference. 

Now, advantage plans are very tailored to the location they’re set to exist in – realistically, the healthcare provider wants to provide an option that will be affordable and desired by a local looking over their option; however, when elaborating on the several different plan names you’ll most commonly find under Humana, we’ll be using a Hamilton, Ohio zip-code for comparative example. You’ll notice that, even though some of the plans listed below may share a “name” with another plan, they will each have a different number associated with the name – by using these plan “codes,” an adequate separation of detail can exist between very, very similar plans under the same umbrella.

  1. The Humana Gold Plus (HMO) – 

As the case with many HMO alike, the Humana Gold Plus is a plan that values cost-effectiveness in lieu of a closed network; essentially, you may find yourself generally paying lower copays, but with some necessary considerations:

  • You’ll be required to select a Primary Care Provider that is in the Humana network, which may mean both leaving your current doctor and having to select a new one. In the case of HMO plans, like the Humana Gold Plus, any visit to a PCP who does not accept your coverage will bill you completely out-of-pocket – this may include costs for the doctor themselves and any procedures completed while there. However, your limitations come with some generous reprieve – you’re given unlimited visits to your doctor, only requiring a relatively small copay each visit, and you may change your doctor to another network-approved option anytime you’d like.
  • You may need to receive any referral to a specialist doctor from your Primary Care Provider. In circumstances where you choose to not receive a referral properly, you may either 1) be required pay the specialist cost entirely out-of-pocket or 2) be turned away by the specialist completely. Through this operation, your plan can keep your costs low, completely covered, and recommended to the best ability (rather than making yourself spend money where you may not need to.) Take note – for many 2019 Humana Gold Plus HMO plans, this process is no longer required.

By comparing a few examples within a zip-code, we get a glimpse of the most comparative options you’ll want to weigh between each plan, especially in consideration of the plan’s ruleset – remember, for the Humana Gold Plus HMO, the lower or non-existent costs arise primarily from a controlled network, allowing for more closely surveyed doctors, facilities, and benefits involved. Additionally, while costs may change, you can always expect an advantage plan to cover equal to, or above, the same coverage you’ll receive through Original Medicare – therefore, most hospital and medical coverage, such as inpatient and outpatient hospital coverage, doctor’s visits, surgeries, and so on, must exist on an advantage plan.

  1. The Humana Gold Plus H6622-021 (HMO)
    • This plan’s premium, plan deductible, drug deductible, preventive care, and primary care provider copay is $0; the copay for a Specialist, however, is $40.
    • $4,900 maximum out-of-pocket responsibility (MOOP)
    • Inpatient and Outpatient Hospital Care is provided – $350 copay per day for days 1-5, then $0 for days 6-90 in Inpatient Hospital; $180 – $250 in Outpatient Hospital, depending on location.
    • Both Emergency Room and Urgent Care are provided – a $90 copay for ER and a $35 copay for UC, respectively.
    • Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, fillings, eyeglasses, and contact lenses.
    • The plan comes with built-in prescription drug coverage at no additional premium – each drug falls into a tier between ranging between 1 to 5 with copays as low as $2 per drug (and as high as 33% of the cost.)
    • Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $172 per day for days 21-100.
    • Transportation is provided – unlimited one-way trips to plan approved locations.
    • You are given an Over-the-Counter Allowance of $50 every 3 months for the purchase of any supplies found in the Humana pharmacy catalog.
    • A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.
  1. The Humana Gold Plus H6622-055 (HMO)
    • This plan’s monthly premium is $15; however, the plan’s deductible, drug deductible, preventive care, and primary care provider copay is $0. When seeing a specialist, you’ll be charged a $25 copay.
    • $3,400 maximum out-of-pocket responsibility (MOOP)
    • Inpatient and Outpatient Hospital Care is provided – $295 copay per day for days 1-6, then $0 for days 7-90 in Inpatient Hospital; $180 – $250 in Outpatient Hospital, depending on location.
    • Both Emergency Room and Urgent Care are provided – a $120 copay for ER and a $20 copay for UC, respectively.
    • Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, fillings, extractions, eyeglasses, and contact lenses.
    • The plan comes with built-in prescription drug coverage at no additional premium – each drug falls into a tier between ranging between 1 to 5 with copays as low as $0 per drug (and as high as 33% of the cost.)
    • Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $172 per day for days 21-100.
    • Transportation is provided – unlimited one-way trips to plan approved locations.
    • You are given an Over-the-Counter Allowance of $75 every 3 months for the purchase of any supplies found in the Humana pharmacy catalog.
    • A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.

Generally, you can expect sizable ancillary coverage from a Humana Gold Plus plan, as you’ll notice that both examples for this area have coverage for dental, vision, and hearing, as well as additional perks like over-the-counter allowance, transportation, and a gym membership through SilverSneakers. Additionally, most Humana Gold Plus plans will have provided drug coverage, meaning that enrollment would bring both your medical and prescriptions under one roof; with this, you’ll be given the opportunity to use Humana themselves as your provider for prescriptions through their mail-order program, which may further reduce the drug costs listed on your plan.

  1. The HumanaChoice (PPO) –

Humana’s PPO, the HumanaChoice plan, is Humana’s provision for those who would prefer an opportunity to branch out their coverage further than just a limited network (and are willing to pay the costs associated with the privilege.) Though some of the coverage may be the same as an HMO counterpart, especially regarding “necessary” coverage like hospital and medical considerations, many ancillary benefits may find themselves altered significantly in the ability to see out-of-network providers – even things like provided prescription drug coverage. In the examples below, take note of how costs drastically differ from plan to another, and compare the importance of out-of-network coverage to the benefits provided by the plan:

  1. The HumanaChoice H5525-042 (PPO):

In this example, many of the out-of-network costs are the exact same as the in-network ones:

  1. This plan’s monthly premium, deductible and preventive care is $0. When seeing your primary care provider, you’ll be charged a $30 copay; for a specialist, it is a $50 copay.
  2. $6,700 maximum out-of-pocket responsibility (MOOP) for both strictly in-network, as well as, for in- and out-of-network costs.
  3. Inpatient and Outpatient Hospital Care is provided – $495 copay per day for days 1-3, then $0 for days 4-90 in Inpatient Hospital; 20% of the cost in Outpatient Hospital, no matter the location.
  4. Both Emergency Room and Urgent Care are provided – a $90 copay for ER and 20% of the cost for UC, respectively.
  5. Medicare-covered dental, vision, and hearing benefits are offered, but with no coverage for hearing aids, fillings, dentures, eyeglasses, or contact lenses.
  6. The plan comes with built-in prescription drug coverage at no additional premium, but with a drug deductible of $250 for Tiers 3, 4 and 5 – each drug falls into a tier between ranging between 1 to 5 with copays as low as $7 per drug (and as high as 28% of the cost.)
  7. Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $172 per day for days 21-100.
  8. Transportation is not offered.
  9. There is no provided Over-the-Counter allowance.
  10. There is no SilverSneakers or equivalent gym membership provided.
  1. The HumanaChoice R5495-001 (Regional PPO) – 

In this example however, you’ll find that out-of-network costs are significantly based on percentages of the actual related service, making your final out-of-pocket costs uncertain:

  1. This plan’s monthly premium and all in-network preventive care is $0. When seeing your primary care provider, you’ll be charged a $20 copay while, for a specialist, it is a $45 copay; for either out-of-network, it is 30% of the cost.
  2. The plan’s combined in- and out-of-network deductible is $1,250.
  3. $6,700 maximum out-of-pocket responsibility (MOOP) for strictly in-network costs; $10,000 MOOP for both in- and out-of-network costs.
  4. Inpatient and Outpatient Hospital Care is provided – $295 copay per day for days 1-6, then $0 for days 7-90 in Inpatient Hospital; costs range between $265-$295 in Outpatient Hospital, depending on location. Out-of-network, you will pay 30% of the cost for either coverage.
  5. Both Emergency Room and Urgent Care are provided – a $90 copay for ER and $35 copay for UC, respectively in-network. However, out-of-network, ER remains the same (a $90 copay) and UC becomes 30% of the cost.
  6. Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, fillings, eyeglasses, and contact lenses.
  7. This plan does not come with provided prescription drug coverage, allowing you to enroll into a separate stand-alone Part D drug coverage alongside this plan.
  8. Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $172 per day for days 21-100; out-of-network, you’ll be charged 30% of the cost.
  9. Transportation is not offered.
  10. You are given an Over-the-Counter Allowance of $30 every 3 months for the purchase of any supplies found in the Humana pharmacy catalog.
  11. A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.

By using the two listed examples, we can correlate our understanding that perks associated with Humana’s PPO plans, including the freedom and choice in using providers either in or out-of-network, will generally require some costs to elevate (or for some benefits to be limited.) However, you’ll notice that many of the costs in-network may end up staying the same as some HMO options – recognize where plans tend to keep their averages and what benefits are most volatile to change!

  1. The Humana Gold Choice (PFFS) –

Though a limited option for enrollment, the Humana Gold Choice PFFS is a unique example of plan that strips the traditional rules of a network’s consideration – essentially, any doctor or facility that accepts Medicare is acceptable to be used while on the Humana Gold Choice, so long as they have accepted your plan’s Terms and Conditions for payment. With this, the plan outlines a certain amount it has agreed to pay those who would accept its terms – including doctors, hospitals and so on – and how much costs for agreed upon services will fall onto you (as the enrollee.) 

With operations very similar to a PPO, costs vary depending on if the coverage is considered in- or out-of-network – remember, just because you are accepted by a provider, does not necessarily mean that they would charge the same as another. Take note how the supreme freedom of the Humana Gold Choice PFFS plan affects its costs below:

  1. The Humana Gold Choice H8145-032 (PFFS):
  1. This plan’s monthly premium is $103. 
  2. Preventive Care is all $0 in-network but could cost up to 30% of the cost out-of-network.
  3. When seeing your primary care provider, you’ll be charged a $20 copay while, for a specialist, it is a $50 copay; for each respective cost out-of-network, it is the same copay.
  4. The plan’s combined in- and out-of-network deductible is $1,850.
  5. $6,700 maximum out-of-pocket responsibility (MOOP) for both strictly in-network costs, as well as for in- and out-of-network costs.
  6. Inpatient and Outpatient Hospital Care is provided – $395 copay per day for days 1-4, then $0 for days 5-90 in Inpatient Hospital; costs for Outpatient Hospital Coverage range, with services at outpatient hospital being a $250 copay in-network (30% of the cost out-of-network) and services at an ambulatory surgical center being $180 copay both in- and out-of-network.
  7. Both Emergency Room and Urgent Care are provided – a $90 copay for ER and $35 copay for UC, respectively in-network; for each respective cost out-of-network, it is the same copay.
  8. Routine dental benefits are offered, but coverage for Hearing and Vision is only limited to Medicare-covered services. 
  9. The plan comes with built-in prescription drug coverage at no additional premium, but with a drug deductible of $250 for Tiers 3, 4 and 5 – each drug falls into a tier between ranging between 1 to 5 with copays as low as $7 per drug (and as high as 28% of the cost.)
  10. Your Skilled Nursing Facility is provided – $0 per day for days 1-20, then $172 per day for days 21-100; out-of-network, you’ll be charged 30% of the cost.
  11. Transportation is not offered.
  12. There is no provided Over-the-Counter allowance.
  13. A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.
  1. Humana Special Needs Plans (SNPS) – 

Though not particularly their own plan (with certain network rules,) a Humana Special Needs Plan is paramount to those who would be applicable for its enrollment, usually including those who have specific health conditions, may be considered “dual-eligible,” or currently stay in a long-term care facility. By drastically reducing, or outright eliminating, costs of a typical policy (like an HMO,) an enrollee can receive all their coverage and benefits at basically no burden to themselves whatsoever; remember – these plans are only for a select few though, and as such, you must fall into one of the two available plan categories:

  1. A Chronic Condition SNP – 
    1. This type of Humana SNP is made available to those enduring a long-term condition, including (but not limited to) diabetes, cardiovascular struggles like chronic heart failure, lung disorders, and end-stage renal disease (known as ESRD.)
  1. A Dual-Eligible SNP – 
    1. This type of Humana SNP is for enrollees who currently receive Medicare and a certain level of Medicaid – this usually includes those who are QMB Plus, QMB, and FBDE, but can include others (with some restriction or potential costs.)

In either case, all your costs (including premiums, deductibles, and otherwise) fall to $0 for any service listed on your plan, and you receive all the ancillary benefits you’d hope to expect with decent coverage including:

  • Dental, vision, and hearing coverage, including coverage for hearing aids, fillings, dentures, eyeglasses, and contact lenses.
  • Unlimited transportation, over-the-counter allowance, and gym membership benefits provided.
  • Provided drug coverage, with drugs only costing between $0 to a maximum of $8.50.

References Used:

https://www.humana.com/medicare/medicare-advantage-plans/humana-gold-plus-hmo
https://www.humana.com/medicare/medicare-advantage-plans/humana-choice-ppo
https://www.humana.com/medicare/medicare-advantage-plans/humana-choice-pffs
https://www.humana.com/medicare/medicare-advantage-plans/humana-special-needs
https://www.humana-medicare.com/BenefitSummary/2019PDFs/R5495001000SB19.pdf
https://www.humana-medicare.com/BenefitSummary/2019PDFs/H5525042000SB19.pdf
https://www.humana-medicare.com/BenefitSummary/2019PDFs/H8145032000SB19.pdf
https://www.humana-medicare.com/BenefitSummary/2019PDFs/H6622015000SB19.pdf
https://www.humana-medicare.com/BenefitSummary/2019PDFs/H6622055000SB19.pdf
https://www.humana-medicare.com/BenefitSummary/2019PDFs/H6622021002SB19.pdf