Last Updated on
March 14, 2018
Private companies like Humana contract with the Medicare program to offer Medicare benefits. With Humana, you have the option of selecting the type of plan for Medicare coverage that may meet your budget and health needs. Not every type of plan Humana offers may be available in the area where you live.
But since all Medicare coverage typically involves Original Medicare in some way, we’ll start with a little background about the program.
Original Medicare: the cornerstone of your Medicare coverage
Original Medicare (Part A and Part B) is health insurance that comes from the federal government.
- Medicare Part A (hospital insurance) coverage generally includes such services as inpatient hospital stays, skilled nursing care, and hospice care.
- Medicare Part B (medical insurance) coverage may include a wide range of services and items, such as doctor visits, preventive care, diagnostic tests and x-rays, and mental health services.
Medicare Part D prescription drug coverage from Humana
Original Medicare (Part A and Part B) includes only limited prescription drug coverage; it generally doesn’t cover prescription drugs you take at home. If you have Medicare Part A and/or Part B, you can sign up for prescription drug coverage through Medicare Part D, which is available from private companies such as Humana that contract with Medicare. You may be able enroll in a stand-alone Medicare Part D Prescription Drug Plan from Humana.
A stand-alone Medicare Part D Prescription Drug Plan is designed to work alongside your Medicare Part A and/or Part B coverage. You may be enrolled in a Medicare Prescription Drug Plan and Medicare Supplement plan at the same time.
Medicare Part D Prescription Drug Plans offered by Humana (as with all Medicare Part D Prescription Drug Plans) use formularies, or lists of covered prescription drugs, to determine coverage. Medications in the formulary are grouped into cost-based benefit categories called tiers. The lower tiers typically include the more affordable generic prescriptions drugs, while the higher tiers include more expensive brand-name and specialty medications.
Humana offers these stand-alone Medicare Part D Prescription Drug Plans that may be available where you live:
- Humana Walmart Rx plans present a cost-effective option, featuring low out-of-pocket costs when members use Humana’s preferred pharmacy network that consists of Walmart, Walmart Neighborhood Market and Sam’s Club pharmacies.
- Humana Preferred Rx plans may offer preferred cost-sharing if you use certain Walmart, Walmart Neighborhood Market, or Sam’s Club pharmacies (no membership required).*
- Humana Enhanced PDP plans provide the most comprehensive coverage of the three plans, with no deductible and a $0 copayment for a 90-day supply of Tier 1 preferred generic medications from the Humana Pharmacy mail delivery service, a mail-order pharmacy.
Typically you pay a monthly premium for prescription drug coverage from one of these plans offered by Humana, unless you are eligible for Extra Help.
Medicare Advantage plans from Humana
Medicare Part C is also called Medicare Advantage. Medicare Advantage plans include all the benefits of Part A and Part B, which cover hospital and medical costs. The one exception is that under Medicare Advantage, Part A still covers hospice care. Many Medicare Advantage plans also include prescription drug coverage. These plans combine health insurance and prescription drug coverage in one plan. Humana offers plans that combine all the benefits of Original Medicare with options to add prescription drug, dental and routine vision and hearing coverage.
To enroll in a Medicare Advantage plan from Humana or any company, you need to be enrolled in Medicare Part A and Part B, and you need to live within the plan’s service area.
Listed below are Medicare Advantage plans offered by Humana that may be available where you live.
- Humana Gold Plus HMO is a Medicare Advantage health maintenance organization (HMO) plan that includes all the benefits of Original Medicare and may include prescription drug coverage and other extra benefits. With this plan, you select a Primary Care Physician from Humana’s network who provides all of your routine care and coordinates any specialty care you require through referrals. Generally you must use the Humana provider network to receive benefits for covered services except in cases of emergency care or as pre-approved by the plan. In an HMO, out-of-pocket costs are typically modest and predictable, allowing you to estimate how much you’ll spend on healthcare during the year.
- HumanaChoice PPO is a Medicare Advantage preferred provider organization (PPO) plan that gives you the freedom to choose from a network of healthcare providers who participate in Humana’s plan or go outside the network.** Typically your out-of-pocket costs are lower when you use healthcare providers who participate in Humana’s PPO network.
- Humana Gold Choice PFFS is a Medicare Advantage private fee-for-service (PFFS) plan. To receive plan benefits, you can see almost any doctor you choose for covered services, as long as the provider accepts Medicare and the Humana Medicare Advantage PFFS Terms and Conditions of Payment.
- A Humana Medicare Advantage Special Needs Plan (SNPs) is a type of Medicare Advantage plan that combines all the benefits of Original Medicare (Part A and Part B) with Medicare prescription drug coverage (Part D). Benefits and additional services are designed around the special needs some Medicare beneficiaries experience. To be eligible to enroll in a Medicare Advantage Special Needs Plan, you must be diagnosed with the condition(s) the plan is designed to support and reside in the area served by the plan. Humana has Medicare Advantage Special Needs Plans designed to help Medicare beneficiaries who are residents of long-term care facilities, who are eligible for Medicare and Medicaid benefit, or who have specific health conditions such as diabetes mellitus, cardiovascular disease, chronic heart failure or chronic lung disorders.
About Medicare Supplement (Medigap) plans
If you have frequent doctor visits, you may have noticed that the coinsurance and copayments can add up fast. Medicare Supplement plans may help pay for Original Medicare’s out-of-pocket costs, such as deductibles, coinsurance and copayments. In most states, Medicare Supplement plans are standardized with letter names, such as Medicare Supplement Plan A (not to be confused with Medicare Part A).
Generally the benefits of a particular Medicare Supplement plan are the same regardless of where you buy the plan. For example, a standardized Medicare Supplement Plan A in Nevada includes the same benefits as a Medicare Supplement Plan A in Georgia and would be the same from any company. But the monthly premium you pay for a Medicare Supplement plan may vary. Every company does not offer all the standardized benefit packages or provide Medicare Supplement insurance in all states.
You must be enrolled in Medicare Part A and Part B to buy a Medicare Supplement plan, and live in the state the policy is issued to purchase. Learn more about eligibility for and enrollment in Medicare Supplement plans.
If you’d like to learn more about Medicare plan options available from Humana, you can click on the Find Plans button on this page. If you prefer, you are welcome to speak with an eHealth licensed insurance agent about Medicare plans from Humana: call 1- 888-323-1149, TTY users dial 711. Monday through Friday, 8AM to 8PM ET.
*Humana’s pharmacy network offers limited access to pharmacies with preferred cost sharing in urban areas of AL, CA, CT, DC, DE, IA, IL, IN, KY, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NH, NJ, NY, OH, OR, PA, RI, SC, SD, TN, VA, VT, WA, WI, WV; suburban areas of AZ, CA, CT, DE, HI, IL, MA, MD, ME, MI, MN, MT, ND, NH, NJ, NY, OH, OR, PA, PR, RI, VT, WA, WV; and rural areas of <AK, IA, MN, MT, ND, NE, SD, VT, WY. There are an extremely limited number of preferred cost share pharmacies in urban areas in the following states: DE, MA, MD, ME, MI, MN, MS, ND, NY, OH, SC, and VT; suburban areas of: MT and ND; and rural areas of: ND. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, please call Customer Care at 1-800-281-6918 (TTY: 711) or consult the online pharmacy directory at Humana.com.
**Out-of-network/non-contracted providers are under no obligation to treat Humana members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Humana MyOption optional supplemental benefits (OSB) are only available to members of certain Humana Medicare Advantage (MA) plans. Members of Humana plans that offer OSBs may enroll in OSBs throughout the year. Benefits may change on January 1st each year.
Humana Inc. and its subsidiaries (“Humana”) do not discriminate on the basis of race, color, national origin, age, disability, or sex.
Humana is a Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. [Benefits, premiums and/or member cost-share] may change on January 1 of each year.
You must continue to pay your Medicare Part B premium.
 The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
 If you live in Massachusetts, Minnesota or Wisconsin, your Medicare Supplement plans and names are different than elsewhere in the U.S.