Humana PPO Insurance Plans: Everything You Should Know

Humana, a commercial insurance corporation, provides Medicare Advantage (Part C) plans.

Humana provides HMO, PPO, PFFS, and SNP plan options.

Not all Humana Medicare Advantage plans may be offered in your location.

Humana was voted top in customer service among all health insurance providers by Newsweek in 2020 for the second consecutive year.

If you’ve already decided to enroll in a Medicare Advantage (Medicare Part C) plan, you still have some choices to make. One of these is the insurer who will provide your coverage.

Humana is a for-profit health insurance business headquartered in Kentucky that is authorized by Medicare to market Part C plans. We’ll discuss Humana’s plans, including their costs, coverage, and more.

Humana Medicare Advantage plan options

Humana PPO Insurance Plans

Humana HMO plans

Many people prefer Health Maintenance Organization (HMO) plans because they are more affordable. Many ZIP codes offer programs with no monthly fee.

These plans are required by law to cover at least as much as original Medicare, ensuring that you receive hospitalization coverage, medical coverage, and preventative care, such as annual screening appointments and vaccines.

As with any HMO, you must select your providers, including your primary care physician (PCP), from the plan’s provider network. Humana provides a Point-of-Service (HMO-POS) plan that allows you to select out-of-network providers in specific situations.

To see specialists and other doctors, you will need a recommendation from your primary care physician.

Humana’s HMOs provide emergency medical care outside the United States.

Some Humana HMOs also offer prescription medication coverage that is comparable to or better than stand-alone Medicare Part D plans.

The majority of these plans include free membership to many local gyms and fitness clubs. This is not an exhaustive list of fitness facilities.

Humana PPO Insurance Plans

Preferred Provider Organization (PPO) plans allow you to choose any Medicare-approved doctor. Out-of-plan providers, on the other hand, will typically charge more.

You will not require a referral to consult a specialist.

These plans offer in-network home health care. They also provide optional add-ons, including vision, dental, prescription drug coverage, and exercise programs.

Emergency care outside of the United States is an additional benefit.

Humana PFFS plans

Private fee-for-service (PFFS) arrangements do not exist everywhere.

With a PFFS plan, you can see any Medicare-approved doctor as long as they accept Humana’s PFFS terms of service and payment.

Humana PFFS plans differ from traditional Medicare and other supplement plans. Humana, not Medicare, will determine what they pay to healthcare providers and hospitals, as well as how much you must pay for your care.

With a PFFS plan, you are not required to select a primary care provider. You also won’t need a referral to consult a specialist.

Most annual preventive tests are free.

Before getting treatment, make sure your doctor has an ongoing agreement with the Humana PFFS network.

Unless you require emergency care, there is no guarantee that the doctor you see will treat you or take your insurance.

Prescription drug coverage is covered in the majority, but not all, of PFFS plans.

Emergency care outside the United States is covered.

Non-network doctors can accept payment through a PFFS plan depending on the service provided or on a case-by-case basis, so you can’t guarantee that a doctor will treat you, even if they’ve treated another patient with the same PFFS plan as you.

Humana SNPs

Special Needs Plans (SNPs) are often free, with no copays, premiums, or coinsurance.

SNPs are only accessible if you meet certain requirements, such as:

If you live in an inpatient facility, like a nursing home, and have a debilitating chronic condition approved by Medicare for an SNP, you may be eligible for both Medicare and Medicaid.

Humana provides two types of SNPs, which are available in roughly 20 states. One type is for individuals who are eligible for both Medicaid and Medicare. The other type is for persons who have specific chronic health concerns, such as:

cardiovascular disease
chronic heart disease
chronic lung disease
diabetes
end-stage renal disease (ESRD)

If you are eligible for a Humana SNP, you will receive all of the benefits of original Medicare plus Medicare Part D.

Health and wellness programs may also be included to treat illnesses like diabetes and provide preventative treatment.

Your SNP may also include normal dental treatment, vision care, hearing care, and non-emergency medical transportation. An over-the-counter (OTC) allowance is typically included for a predetermined quantity.

Humana Part D Options

Humana offers three different Part D prescription medication plans. These Part D programs are meant to help patients control the expense of prescription drugs.

Humana Walmart ValueRx Plan

Humana’s Walmart Value Rx Plan includes preferred cost-sharing partners such as Walmart, Walmart Neighborhood Markets, and Sam’s Club pharmacies.

This allows Humana to provide additional prescription savings to customers who buy their drugs at Walmart.

The Humana Walmart Value Rx Plan provides the following benefits:

$17.20 monthly plan premium nationwide
$0 deductible on tier 1 and 2 medications
$445 annual deductible on tiers 3 through 5 medications

Walmart, Walmart Neighborhood Markets, and Sam’s Club provide in-store copays as low as $1 for a 30-day supply of some generic pharmaceuticals.

Humana’s mail-delivery pharmacy offers copays as low as $3 for tier 1 preferred generics over 90 days.

The plan’s list of covered pharmaceuticals includes approximately 3,500 prescriptions.

Before you choose the Humana Walmart Value Rx Plan, be sure you reside near a Walmart that offers pharmacy services.

While you can use other pharmacies with this plan, you will not receive any further discounts unless you use Humana’s preferred cost-sharing partners.

Humana Premier Rx Plan

The Humana Premier Rx Plan, like the Walmart Value Rx Plan, makes Walmart its preferred cost-sharing partner.

This means that residing close to a Walmart is essential for saving the most money on your medicines.

While this plan has a larger premium than the Walmart Value Rx Plan (from $58.30 to $72.50 per month, depending on your state or location), the Humana Premier Rx Plan offers the following benefits:

Tier 1 and 2 drugs have a $0 deductible.

Humana’s mail-delivery pharmacy service offers 90-day supplies of tier 1 and 2 drugs with no copays.

Humana Pharmacy, Walmart Neighborhood Markets, Sam’s Club, Publix, Kroger, Harris Teeter, HEB, and Costco pharmacies offer preferential cost-sharing.

The annual deductible for tiers 3 through 5 drugs is $445 nationwide, and $305 in Puerto Rico.

The plan’s list of covered pharmaceuticals includes approximately 3,700 prescriptions.

Humana’s Basic Rx Plan

Unlike Humana’s other Part D plans, the Humana Basic Rx Plan allows you to select your pharmacy, as long as it is in the plan’s network.

Humana Basic Rx Plan prices vary by state and location, ranging from $19.70 to $45.00 per month. The plan has an annual deductible of $445.

The Humana Basic Rx Plan provides the following benefits:

$1 cost for a 30-day supply of Tier 1 drugs.
All in-network normal retail pharmacies charge a $4 copay for a 30-day supply of Tier 2 drugs after the deductible.
Humana’s mail-delivery pharmacy offers preferred cost-sharing, with a $0 payment for a 90-day supply of tier 1 and 2 drugs (after deductible).

Humana PPO Insurance Plans pros and cons

Humana’s offers have pros and cons:

Pros

Widely available: Humana offers plans in 94% of U.S. counties, making it a viable option for the majority of Americans.
Quality plans: Humana has 25 contracts rated 4 stars or above (out of 5) for 2024, which cover nearly all of its current Medicare Advantage subscribers. Four 2024 contracts scored five stars.
Solid member ratings: According to the most recent J.D. Power research, Humana has higher customer satisfaction than the industry average in numerous major Medicare areas.
Veteran Focus: Humana USAA Honor plans to interact with veteran benefits to provide a comprehensive package of health care for those who served.

Cons

Special needs plans (SNPs) are not available everywhere. Humana’s SNPs are currently offered in 38 US states and Puerto Rico.
Mixed reviews: Despite Humana’s high member experience numbers, the National Committee for Quality Assurance rates numerous Humana plans as 3 or below out of 5 on its rating scale.

Conclusion

Humana provides a wide choice of Medicare Advantage plans throughout the majority of the country.

The law requires these programs to provide at least as much coverage as original Medicare.

Most plans include additional forms of coverage, such as vision, dental, and prescription medicines. The plan you select must service your ZIP code. Costs vary according to the plan.

Humana PPO Insurance Plans: Everything You Should Know