Humana & Medicare Advantage

Humana will likely be one of your options when looking for a Medicare Advantage plan. The insurance company services more than 8 million Medicare beneficiaries in all 50 states in the U.S. Humana offers a wide range of plan types, from HMO to preferred provider organization (PPO) or special needs plans (SNP) — all of which have different advantages, benefits and qualifications.

Humana Medicare Advantage Plans Coverage

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 different types of plans available through Humana.

HMO Plans

HMO Plans are a common Medicare Advantage option for beneficiaries, and they are 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 also may 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. According to Humana, the average maximum out-of-pocket for 2021 was $4,679.

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.

PPO Plans

If you opt for a PPO Plan from Humana, then 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.

Private Fee-for-Service (PFFS) Plans

A Humana PFFS Plan offers you the flexibility to go to any doctor as long as 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 with other plans, you also will have emergency coverage.

Special Needs Plans (SNPs)

An SNP is designed for people who have specific diseases or qualifying conditions and exist to offer them coverage and support those needs. SNPs can offer benefits catered to the specific condition that they cover. These plans include everything covered under Part A and 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.

Conditions with Humana SNPs
  • Cardiovascular Disorders
  • Chronic Heart Failure
  • Chronic Lung Disorders
  • Diabetes Mellitus
Source: Humana.com

Average Cost of Humana Medicare Advantage Plans

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. Humana does offer $0 premium options, helping to keep your Medicare Advantage plan costs down. This option is available on several different plans, but remember that it doesn’t mean your coverage is free. You still have to pay your Part B premium.

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

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Pros and Cons of Medicare Coverage from Humana

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 available in just 20 states and there are additional limitations on the type of condition covered — like the state of Georgia, which technically has SNPs, but only for diabetes.

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, with some exceptions, Humana’s customer satisfaction tends to be high. In July 2021, a J.D. Power pharmacy study ranked Humana first in customer satisfaction for mail order.

Average Rating of Humana

Humana typically has solid ratings. According to the company, 92 percent of its available plans in 2021 achieved a four-star rating from Medicare’s Star Ratings. This equates to more than 4 million beneficiaries who are on a plan that is rated four stars or higher.

Humana’s highly-rated plans are also not concentrated regionally, with one four-star plan available in more than 40 states. Humana also has some plans that were unrated because they were recently released.

Last Modified: October 21, 2021

5 Cited Research Articles

  1. Humana (2021, August 24). Humana Gold Plus Medicare Advantage HMO Plans. Retrieved from https://www.humana.com/medicare/medicare-advantage-plans/humana-gold-plus-hmo
  2. Humana (2021, July 28). Humana Ranks #1 for Customer Satisfaction for Mail Order for Four Consecutive Years in J.D. Power U.S. Pharmacy Study. Retrieved from https://press.humana.com/news/news-details/2021/Humana-Ranks-1-for-Customer-Satisfaction-for-Mail-Order-for-Four-Consecutive-Years-in-J.D.-Power-U.S.-Pharmacy-Study/default.aspx#gsc.tab=0
  3. Kaiser Family Foundation (2021, June 21). Medicare Advantage in 2021: Star Ratings. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2021-star-ratings-and-bonuses/
  4. Humana (2020, October 8). 92% of Humana’s Medicare Advantage Members are in 4-Star and Above Contracts for 2021, Reflecting Ongoing Commitment to Quality Care and Improved Health Outcomes. Retrieved from https://press.humana.com/news/news-details/2020/Humanas-Medicare-Advantage-Members-are-in-4-Star-and-Above-Contracts-for-2021-Reflecting-Ongoing-Commitment-to-Quality-Care-and-Improved-Health-Outcomes/default.aspx#gsc.tab=0
  5. Humana (2020, October 1). Humana Medicare Advantage Special Needs Plans. Retrieved from https://www.humana.com/medicare/medicare-advantage-plans/humana-special-needs