Humana & Medicare Advantage
Humana will likely be one of your options when looking for a Medicare Advantage plan. In 2022, the insurance company services 5 million Medicare beneficiaries in all 50 states in the U.S. Humana offers a wide range of plan types, from health maintenance organization (HMO) to preferred provider organization (PPO) or special needs plans (SNP) — all of which have different advantages, benefits and qualifications.
- Written by Christian Simmons
Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics. Christian is a former winner of a Florida Society of News Editors journalism contest and has written professionally since 2016.Read More
- Edited ByLee Williams
Senior Financial Editor
Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.Read More
- Published: October 15, 2021
- Updated: September 21, 2022
- 4 min read time
- This page features 7 Cited Research Articles
- Edited By
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 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 may also 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 the Kaiser Family Foundation, the average maximum out-of-pocket limit for HMO Medicare Advantage enrollees in 2022 is $4,365.
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.
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 Private Fee-for-Service plan, or 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. Similar to other plans, you also will have emergency coverage.
Special Needs Plans (SNPs)
A special needs plan, or 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.
- Cardiovascular Disorders
- Chronic Heart Failure
- Chronic Lung Disorders
- Diabetes Mellitus
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.
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. A 2022 J.D. Power Medicare Advantage study ranked Humana in second place for overall plan satisfaction.
Average Rating of Humana
Humana typically has solid ratings. According to the company, 97% of its available plans in 2022 achieved a four-star rating from Medicare’s Star Ratings.
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.
7 Cited Research Articles
- Freed, M. & et al. (2022, August 25). Medicare Advantage in 2022: Premiums, Out-of-Pocket Limits, Cost Sharing, Supplemental Benefits, Prior Authorization, and Star Ratings. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-premiums-out-of-pocket-limits-cost-sharing-supplemental-benefits-prior-authorization-and-star-ratings/
- Freed, M. & et al. (2022, August 25). Medicare Advantage in 2022: Enrollment Update and Key Trends. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/
- J.D. Power. (2022, August 18). Customers Perceive Shortfall in Medicare Advantage Plan Coverage of Mental Health and Substance Abuse Services, J.D. Power Finds. Retrieved from https://www.jdpower.com/business/press-releases/2022-us-medicare-advantage-study
- Humana. (2022). How Medicare Star Ratings Can Help You Choose—And Help You Save. Retrieved from https://www.humana.com/medicare/cms-star-ratings
- 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
- 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/
- Humana (2020, October 1). Humana Medicare Advantage Special Needs Plans. Retrieved from https://www.humana.com/medicare/medicare-advantage-plans/humana-special-needs
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