How Does Humana Medicare Advantage Work?

A Medicare Advantage plan is Part C of the Medicare statute. It allows private insurers to offer a wider range of benefits than Original Medicare offers, sometimes with a zero plan premium. (You will be required to be eligible for Medicare Part A and have selected Medicare Part B in order to enroll in a Medicare Advantage plan.) Medicare Advantage plans almost always offer prescription drug coverage, so you will not need to sign up for Medicare Part D.

You can choose a Medicare Advantage plan anytime in the seven-month period centered on the month in which you turn 65, or during one of the open enrollment periods. You can also switch from Original Medicare to Medicare Advantage during the open enrollment periods. You can change Medicare Advantage plans during an open enrollment period or between January 1 and March 31 of each year.

What Is Special About Humana?

Humana offers several of the best-regarded Medicare Advantage plans. They are:

• Humana Gold Plus Health Maintenance Organization (HMO);

• Humana Choice Preferred Provider Organization (PPO);

• Human Gold Choice Fee-for-Service (FFS); and,

• Humana Special Needs Plans (SNP).

What Are the Features of These Plans?

Humana is trying to cover all the bases, offering plans that mirror established ways of delivering care. The HMO plan requires you to select a primary care provider who manages your care and coordinates with specialists when necessary. You go to the primary care provider first for all your health care needs.

The PPO plan uses a panel of approved providers, but you are not required to seek care through a primary care provider. You can go to any provider, but your costs will be higher for those not participating in the PPO.

The FFS plan allows you to go to any doctor of your choice, whether or not they participate in an HMO or PPO with Humana.

Costs will be higher when Humana does not control the providers you access, so the HMO plan is usually cheapest, with the PPO plan more expensive and the FFS plan most expensive.

The SNP plans are designed for people with chronic conditions, are jointly eligible for Medicare and Medicaid, or are a resident of a long-term care facility. Many of these plans have a zero monthly premium.

Of course, Humana offers Medicare Supplement Plans, Part D (prescription drug) plans, and vision and dental plans. The Supplement and Part D plans are designed to work with Medicare; the vision and dental plans are not Medicare-related.

Which Plan Should I Choose?

A few general pointers are that if you are often ill and want the widest choice of providers, you should consider the FFS plan. If you are concerned about costs, the HMO plan would be a good choice. If you have one or more chronic conditions, consider the SNPs. Advice from a professional insurance agent can be found at Medicarehealthinsurancefacts.com or by calling (877) 829-1109.