Humana is the second-largest supplier of Medicare Benefit plans , and the supplier that’s out there to the most individuals, with plans provided in additional than 8 out of 10 U.S. counties. Most of its Medicare Benefit clients are in high-quality plans rated 4 stars or larger by the Facilities for Medicare & Medicaid Companies, and the corporate presents some good perks with many plans.
Though most of Humana’s Medicare beneficiaries are in high-rated plans, some contracts get decrease scores on buyer satisfaction than others, so it’s value doing all your analysis earlier than you signal on.
Right here’s what it’s best to learn about Humana Medicare Benefit.
Humana Medicare Benefit execs and cons
Humana’s choices have benefits and drawbacks:
Most generally out there: With plans out there in 2,703 U.S. counties (or 84%), Humana is an choice for extra Individuals than some other supplier.
High quality plans: Though Humana has plans with decrease star rankings from the CMS, the supplier has 15 contracts rated 4 stars or larger (out of 5) that embody 92% of its present Medicare Benefit members.
COVID-19 perks: Humana presents $0 copays for COVID-19 testing, and for members with a COVID-19 analysis, there’s a $0 copay for therapy and 14 days of home-delivered meals.
Entry to a top-rated mail-order pharmacy. Ordering your common prescriptions for mail supply can lower your expenses, and Humana Pharmacy tops the listing in buyer satisfaction, in line with J.D. Energy .
Particular wants plans aren’t out there all over the place: At the moment, Humana’s Twin-Eligible SNPs can be found in about half of U.S. states (26), and the corporate’s Persistent Situation SNPs can be found in solely 12 states .
Combined evaluations: Though J.D. Energy ranked Humana third-highest Medicare Benefit insurer in its 2020 member satisfaction examine, a variety of plans had been ranked 3.0 or beneath out of 5 by the Nationwide Committee for High quality Assurance.
Obtainable Medicare Benefit plans
Humana presents a number of sorts of Medicare Benefit plans, and so they range when it comes to construction, prices and advantages out there. Many plans provide dental and imaginative and prescient advantages, worldwide emergency care, and health advantages by SilverSneakers.
Generally, Humana presents Medicare Benefit Prescription Drug Plans in addition to stand-alone Prescription Drug Plans and Medicare Benefit Plans with out drug protection. It’s additionally value noting that Humana Honor, the corporate’s Medicare Benefit plan that’s aimed towards U.S. navy veterans, has been expanded into 46 states in its second 12 months of operation.
Different plan choices embody the next varieties:
A well being upkeep group typically requires that you just use a particular community of medical doctors and hospitals. It’s possible you’ll want a referral out of your major physician in an effort to see a specialist, and out-of-network advantages are often very restricted.
Most popular supplier group plans present essentially the most freedom, permitting you to see any supplier that accepts the insurance coverage. It’s possible you’ll not want to decide on a major physician, and also you don’t want referrals to see specialists. You possibly can search out-of-network care, though it could price greater than seeing an in-network physician.
Humana’s non-public fee-for-service plans permit you to see any Medicare-approved supplier who accepts your Humana plan. You gained’t have to select a major physician, and also you gained’t want a referral to see a specialist.
Particular wants plans limit membership to individuals with sure illnesses or traits. Therefore, the advantages, community and drug formularies are tailor-made to the wants of these members. Humana presents two sorts of SNPs:
Persistent Situation SNP: For individuals with a number of of those circumstances:
Twin-Eligible SNP: For people who find themselves entitled to Medicare and who additionally qualify for help from a state Medicaid program.
Obtainable Half D prescription drug plans
Whereas a lot of Humana’s Medicare Benefit plans embody Medicare Half D drug protection, the corporate additionally sells stand-alone Half D prescription drug plans. These plans are supposed to accompany Medicare Half A and Half B and don’t present medical protection.
Humana presents three stand-alone prescription drug plans in 2021, with common month-to-month premiums that vary from $17.20 to $72.50:
Humana Walmart Worth Rx Plan: Month-to-month premium of $17.20, prices as little as $1 copay and $0 deductible on Tier 1 and Tier 2 medication, and entry to a large community of pharmacies, together with however not restricted to Walmart.
Humana Premier Rx Plan: Month-to-month premium of $58.30 to $72.50, prices as little as $0 copay and $0 deductible on greater than 900 Tier 1 and Tier 2 medication, and a broad community of pharmacies.
Humana Primary Rx Plan: Month-to-month premium of $19.70 to $45, prescription deductible of $445 on all tiers. This plan is aimed toward members who qualify for Additional Assist, who might be able to get the total price of premiums coated. Additional Assistance is a Medicare program that gives help to individuals with restricted earnings and sources.
Humana Medicare Benefit presents most members entry to routine imaginative and prescient and dental protection. A lot of its plans provide different advantages as nicely. Listed here are just a few standouts:
Most plans embody SilverSneakers, which provides you entry to collaborating gyms, neighborhood facilities, on-line health lessons, wholesome dwelling reductions and a health app, amongst different issues.
Should you’re recovering from an inpatient keep at a hospital or expert nursing facility, otherwise you’re enrolled in a professional continual situation SNP, you possibly can obtain dwelling supply of a sure variety of meals.
About half of Humana’s Medicare Benefit Prescription Drug Plans and a 3rd of its Half D plans provide this profit that helps members pay much less for diabetes drugs.
All members of Humana’s Twin-Eligible Particular Wants Plans have entry to a Wholesome Meals Card, which gives members a month-to-month allowance of as much as $75 to buy authorised wholesome meals and drinks.
Some plan members might get an allowance they’ll put towards over-the-counter objects like cough and chilly meds, first-aid provides, nutritional vitamins and ache relievers.
All Medicare Benefit members get $0 telehealth copays for visits with a major care physician, pressing care, and outpatient behavioral well being.
As talked about above, Humana members can benefit from $0 copays for COVID-19 testing, and for members with a COVID-19 analysis, there’s a $0 copay for therapy and 14 days of home-delivered meals.
Humana members can contact their plan’s customer support within the following methods:
Humana Medicare Benefit service space
Humana presents Medicare plans and Medicare prescription drug plans in all 50 states, Washington, D.C., and Puerto Rico, and the corporate presents Medicare Benefit plans in 46 states and Puerto Rico. In all, Humana Medicare Benefit is obtainable in 84% of counties — essentially the most of any supplier . Eighty-seven p.c of Medicare beneficiaries have the choice of a Humana plan.
For the 2021 plan 12 months, Humana expanded its HMO choices into 125 new counties and launched native PPO plans in 98 new counties.
General, Humana is the fourth-largest well being insurer within the nation , and it’s the second-largest amongst for-profit well being plans . Almost 4.5 million Medicare beneficiaries are enrolled in a Humana Medicare Benefit plan , and the corporate added 369,000 new members for the 2021 plan 12 months.
Prices for Medicare Benefit plans will rely in your plan, your geographic location and your well being wants. One of many prices to contemplate is the plan’s premium, and Humana has expanded its choices of $0-premium plans. In 2021, the corporate estimates that just about 6 out of 10 of its members are in $0-premium plans that supply care coordination companies and enhanced advantages not provided underneath Unique Medicare.
At the same time as a Medicare Benefit person, you’ll nonetheless be liable for paying your Medicare Half B premium, which is a minimum of $148.50 in 2021. (Most individuals pay this customary quantity, but when your earnings is above a sure threshold, you will pay extra.)
Different out-of-pocket prices to contemplate embody:
Whether or not the plan covers any a part of your month-to-month Medicare Half B premium.
The plan’s yearly deductibles and some other deductibles, similar to a drug deductible.
Copayments and/or coinsurance for every go to or service. As an example, there could also be a $10 copay for seeing your major physician and a $45 copay for seeing a specialist.
The plan’s in-network and out-of-network out-of-pocket maximums.
Whether or not your medical suppliers are in-network or out-of-network, or how usually chances are you’ll go out-of-network for care.
Whether or not you require further advantages, and if the plan costs for them.
To get a way of prices, use Medicare’s Plan Finder to check info amongst out there plans in your space. You possibly can choose by insurance coverage provider to see solely Humana plans, or evaluate throughout carriers. You can even store instantly from Humana’s web site by coming into your ZIP code, and also you’ll be capable to evaluate the plans out there.
Medicare star rankings
The Facilities for Medicare & Medicaid Companies preserve its personal database of star rankings on each Medicare Benefit and separate Medicare Half D plan, starting from finest (5 stars) to worst (1 star). The company bases these rankings on plans’ high quality of care and measurements of buyer satisfaction, and rankings might change from 12 months to 12 months. You’ll find a plan’s score with the Medicare Plan Finder.
Based mostly on the latest 12 months of information, Humana’s Medicare Benefit plans get a median score of three.6, and the corporate’s prescription drug plans (Half D) get a median rating of three.8. The general common rating for Humana’s plans is 3.7 . For comparability, the common star score for plans from all suppliers was 4.06 .
That stated, Humana notes that 92% of its Medicare Benefit members who’re in rated contracts (4.1 million individuals) are in contracts with 4 stars or extra in 2021 . Three Medicare Benefit contracts obtained 4.5 stars, and one contract — CarePlus Well being Plans Inc. — obtained 5 stars and covers roughly 164,300 members. There have been additionally 12 Humana contracts that had been too new to be measured.
To get an general star score, the CMS ranks contracts on 46 plan elements. Right here’s the place Humana plans actually delivered, with common scores of 4.5 (out of 5) and above:
Grownup BMI evaluation (checking to see if members are at a wholesome weight).
Look after older adults – treatment evaluate (yearly evaluate of all drugs and dietary supplements being taken).
Look after older adults – useful standing evaluation (yearly evaluation of how nicely plan members are in a position to do actions of each day dwelling).
Look after older adults – ache evaluation (p.c of plan members who had a ache screening a minimum of as soon as through the 12 months).
Complaints concerning the well being plan (extra stars imply fewer complaints).
Reviewing appeals selections (equity of the plan’s enchantment selections, based mostly on an impartial reviewer).
International language interpreter and TTY availability (availability of teletypewriter companies and overseas language interpretation when potential members name the plan).
Complaints concerning the drug plan (extra stars imply fewer complaints).
MPF value accuracy (plan gives correct Medicare Plan Finder drug pricing info for the web site).
In some classes, Humana contracts averaged a sub-3.0 rating:
Breast most cancers screening (p.c of feminine plan members ages 52 to 74 who had a mammogram prior to now two years).
Annual flu vaccine (p.c of plan members who received a flu shot).
Enhancing or sustaining bodily well being (p.c of plan members whose bodily well being was the identical or higher than anticipated after two years).
Osteoporosis administration in girls who had a fracture (p.c of feminine members who broke a bone and received screening or therapy for osteoporosis inside six months).
Enhancing bladder management (p.c of members with a urine leakage concern prior to now six months who talked about therapy choices with a supplier).
Ranking of well being plan (member’s score on a scale of 0 to 100).
There are just a few corporations that weigh in on well being plans or on the energy of the corporate in query, and we’ve included three right here:
A.M. Greatest is a credit standing company that focuses on the insurance coverage trade. In August 2020, A.M. Greatest affirmed its Monetary Power Ranking of A- (Glorious) for almost all of medical health insurance subsidiaries of Humana Inc. .
A.M. Greatest additionally affirmed an FSR of A- for Humana’s dental subsidiaries, and affirmed an FSR of B++ (Good) for Humana Insurance coverage of Puerto Rico Inc. and Humana Well being Plans of Puerto Rico Inc., that are Humana subsidiaries.
An A- score on this class signifies that A.M. Greatest believes Humana has a wonderful potential to fulfill its ongoing insurance coverage obligations. (The 2 subsidiaries with a B++ score are deemed to have a “good” potential to fulfill ongoing insurance coverage obligations.)
In its 2020 U.S. Medicare Benefit Examine — the sixth it is achieved thus far — J.D. Energy measured member satisfaction with Medicare Benefit plans based mostly on six elements: protection and advantages, supplier alternative, price, customer support, info and communication, and billing and cost. On these measures, Humana scored 806 factors out of 1,000 and got here in third out of the highest 10 Medicare Benefit suppliers .
The Nationwide Committee for High quality Assurance charges medical health insurance plans on a 5-point scale (with 5 being finest) based mostly on medical high quality, member satisfaction and outcomes from the NCQA Accreditation Survey. The rankings spotlight the outcomes of care and what sufferers say about their care.
In its 2019-2020 rankings of Humana plans (there have been no rankings in 2020), NCQA awarded rankings between 4.0 and a couple of.0, with the majority receiving 3.5, 3.0 or 2.5 rankings . The highest rated plans with scores of 4.0 had been Cariten Well being Plan Inc., Humana Profit Plan of Illinois Inc. and Humana Medical Plan Inc. of Florida. One plan — Humana Insurance coverage Firm of Florida — obtained a 2.0 score, with low scores on buyer satisfaction and prevention, a class that signifies how nicely plans present preventive companies.
Discover the best Medicare Benefit plan
It’s essential to do your analysis earlier than deciding on a well being plan for your self. Listed here are some questions to contemplate asking:
What are the plan’s prices? Do you perceive what the plan’s premium, deductibles, copays and/or coinsurance can be? Are you able to afford them?
Is your physician in-network? You probably have a most popular medical supplier or suppliers, be certain they take part within the plan’s community.
Are your prescriptions coated? Should you’re on treatment, it’s essential to know how the plan covers it. What tier are your pharmaceuticals in, and are there any protection guidelines that apply to them?
Is there dental protection? Does the plan provide routine protection for imaginative and prescient, dental and listening to wants?
Are there extras? Does the plan provide any further advantages, similar to health memberships, transportation advantages or meal supply?
You probably have further questions on Medicare, go to Medicare.gov or name 1-800-MEDICARE (1-800-633-4227, TTY 877-486-2048).
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