Humana Medicare Insurance Review

Pros Explained

  • Widely available across the country: Humana Medicare Advantage plans are available in more counties than any other insurer, and at least one type of Humana Medicare plan is available in every state plus Puerto Rico.

  • High-quality plans: 97% of Humana Medicare Advantage members were enrolled in a plan rated 4 stars or higher by CMS, which oversees Medicare.

    J.D. Power also ranked Humana fourth overall in its 2021 U.S. Medicare Advantage Study.

  • Special pricing at Walmart for certain Prescription Drug Plans: Humana offers a relatively low-cost Stand-alone Prescription Drug Plan co-branded with Walmart, which gives members lower costs when they get their prescriptions at Walmart locations.
  • Humana Pharmacy is number one for mail-order prescriptions: All Humana Medicare members with prescription drug coverage with mail-order benefits can use Humana Pharmacy, the top-rated mail-order prescription service, according to J.D. Power.

Cons Explained

  • Some Humana plans do not score well for satisfaction: NCQA, the accrediting body, gives Humana plans mixed results, with several subsidiaries scoring poorly on customer satisfaction.

  • Humana’s ownership may change: Any company can be acquired, but Humana has been an acquisition target in the past, and previous reports suggested Walmart would purchase them.

Available Plans

Humana offers several Medicare Advantage plan options, with different benefits, costs, and rules.

HMO Plans 

Humana’s Medicare Advantage HMO plans typically need a referral from your primary care provider (PCP) to see specialists, but you can switch PCPs if you’re not happy. These plans cover the benefits of Original Medicare along with extra benefits. Most Humana HMO plans include SilverSneakers fitness benefits, and many include prescription drug coverage.

PPO Plans

Humana’s PPO plans allow you to visit any Medicare-approved doctor without a referral, regardless of whether they specifically participate in Humana’s provider network. Your costs will generally be lower when you visit in-network health care providers. Specific benefits vary depending on location, but many of these plans include home health services, prescription drug coverage, and extra benefits such as fitness programs, vision, and dental. Humana’s PPO plans also cover you when you travel outside the U.S.

Private Fee-for-Service Plans

On a private fee-for-service (PFFS) plan, you’re generally not required to have a PCP or get referrals to see specialists, but Humana establishes a network of providers to ensure members can access the care they need.

In some areas, Humana offers PFFS plans with no preferred provider network, which means members can see any provider who accepts Medicare fee-for-service rates. Humana’s PFFS plans cover most annual preventive screenings, hospitalization, and emergency and urgent care; most also cover prescription drugs.

Stand-alone Prescription Drug Plans 

Stand-alone Prescription Drug Plans (PDP) cover medications that fall into the Medicare coverage gap but do not offer any medical coverage or other benefits. These plans work alongside Original Medicare Parts A and B. Humana offers three PDP options.

The Humana Walmart Value Rx Plan has the lowest premiums and low copayments on Tier 1 and 2 drugs, but higher-tier drugs cost more and are subject to a deductible. The Humana Premier Rx Plan is the most comprehensive option from Humana, with more than 3,700 covered prescription drugs, though premiums are higher than the other plans.

The Humana Basic Rx Plan is designed for people who qualify for Extra Help, a Medicare program to help people with limited income pay for prescriptions; this plan includes free or very low-cost prescriptions.

Medicare Supplement (Medigap) Insurance 

Medicare Supplement plans, also known as Medigap, cover some of the costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. There are eight standardized plans that cover different costs; not all are available in every state. Medigap plans do not cover prescriptions and cannot be combined with certain other coverage like a Medicare Advantage plan.

Humana offers the following Medigap plans, though availability varies by state: 

  • A: Supplements coinsurance or copayments for Medicare Parts A and B
  • B: Supplements Parts A and B coinsurance or copayments and Part A deductible
  • C: Supplements Parts A and B coinsurance, and deductibles, plus skilled nursing facility coinsurance and foreign travel emergency
  • F: Supplements everything in Medigap C plus Part B excess charges
  • G: Supplements Parts A and B coinsurance, Part A deductibles, Part B excess charges, plus skilled nursing facility coinsurance and foreign travel emergency
  • K: Supplements Part A coinsurance or copayments (100%) and Part A hospice coinsurance or copayment and deductible plus Part B coinsurance or copayment and skilled nursing facility (50%)
  • L: Supplements Part A coinsurance or copayments (100%) and Part A hospice coinsurance or copayment and deductible plus Part B coinsurance or copayment and skilled nursing facility (75%)
  • N: Supplements Parts A and B coinsurance, and Part A deductibles, plus skilled nursing facility coinsurance and foreign travel emergency

Medicare Advantage Special Needs Plans 

Humana offers two types of Special Needs plans: Dual-eligible Special Needs plans (D-SNP) and Chronic Condition Special Needs plans (C-SNP) for people with at least one chronic condition such as diabetes, and cardiovascular disease, chronic heart failure, or chronic lung disorders.

These plans are Medicare Advantage plans for people who have both Medicare and Medicaid. C-SNPs and D-SNPs offer all the benefits of Medicare Advantage and additional benefits specific to the specific member populations’ needs that the private insurer may choose to include.

Humana SNP members get personalized support to help manage their conditions, such as care coordination or other extra benefits to meet specific members’ needs. Some Humana SNP plans offer routine dental, vision, and hearing benefits, non-emergency transportation, fitness programs, and over-the-counter medication allowances.

Many Humana SNP plans have low or no monthly premiums.

Limited Income Newly Eligible Transition 

The Medicare Limited Income Newly Eligible Transition (LI-NET) program provides temporary drug coverage for people who qualify for Medicare low-income subsidies, also called Extra Help, and who qualify for Medicare and Medicaid or Supplemental Security Income. The program covers prescriptions temporarily until the Medicare member enrolls in a Prescription Drug Plan.

Extra Benefits

Most Medicare Advantage plans offer extra benefits, such as fitness, dental, and vision, as well as hearing aids, over-the-counter medications, and meal benefits. These benefits have become increasingly common. In 2022, 95% of Medicare Advantage plans also offer telehealth benefits. 

Most of Humana’s Medicare Advantage plans, including Dual-eligible Special Needs plans, offer dental and vision benefits, over-the-counter medication allowance, fitness programs, and home-delivered meals after a hospital stay.

Humana offers an Insulin Savings Program in some of their MAPD and Stand-alone Prescription Drug Plans. This program caps the cost of diabetes medications at $35 for a 30-day supply of certain insulins.

Humana offers Medicare members other wellness programs, including:

  • Go365, a program that rewards members for engaging in healthy behaviors
  • SilverSneakers, a fitness benefit with a wide range of programs
  • Healthy Foods Cards for Dual-eligible Special Needs plan members so they can buy healthy foods and beverages
  • Humana Well Dine, a meal delivery program for members recovering from hospitalizations or managing a chronic condition

Humana supports members with complex health needs with care management and helps to manage chronic diseases. Some Medicare Advantage members can get Humana At Home services from a personal care manager who helps people remain independent at home.

Customer Service

Humana’s customer service is available by phone or by requesting an appointment online. Phone support for Medicare plans is available seven days a week between 8 a.m. and 8 p.m. ET at 800-457-4708.

For Special Needs plans, call 888-328-6498 between 5 a.m. and 8 p.m. ET, seven days a week.

Members and prospective members can get information and perform certain tasks like finding forms or paying premiums online. Humana members can chat with customer service and download the MyHumana app, which lets members check coverage and benefit details, view their member ID card, view claims, and find providers.

Humana also offers to answer basic questions on Twitter seven days a week, between 6 a.m. and 8 p.m. To protect privacy, you are not able to resolve personal questions or issues via social media.

Customer Satisfaction 

The National Association of Insurance Commissioners (NAIC) tracks complaints against insurers of all types, including health insurers. In its complaint index, a score of less than one means the insurer received fewer than expected complaints; a score of greater than one means they received more than expected.

Humana’s overall complaint index was .87 in 2021, an improvement from 1.23 in 2020. Humana’s Medicare Supplement Insurance is above average.

Third-Party Ratings

AM Best

AM Best, the credit rating agency that assesses insurance companies’ financial strength, affirmed its A- (Excellent) Financial Strength Rating of Humana and most of its health insurance subsidies. An A- rating indicates that the company has an excellent ability to meet its ongoing insurance obligations.

NCQA

The National Committee for Quality Assurance (NCQA) is a leading health plan accreditation organization that rates health plans based on health care quality and customer satisfaction measures. In the 2019–2020 ratings, Humana plans scored between 2 and 4 out of 5. These composite scores include customer satisfaction measures, including satisfaction with the consumer’s ability to get needed care, satisfaction with the doctors, and satisfaction with the health plan. 

Several Humana plans scored 4 out of 5 on satisfaction with the health plan, the most direct measure of the plan’s customer service and experience, compared with physician satisfaction or overall ratings.

The overall NCQA rating doesn’t tell the whole story. A high overall score can hide lower satisfaction with the health plan itself, and a lower overall score does not mean members aren’t extremely satisfied with the health plan.

J.D. Power

In its 2021 U.S. Medicare Advantage Study, J.D. Power measured member satisfaction with Medicare Advantage plans. On the overall customer satisfaction index, Humana ranked fourth overall with a score of 822 points out of 1,000, placing it just above the industry average of 806.

Medicare Star Ratings

The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage and Prescription Drug Plans on a five-star quality rating system. These ratings are based on how well the plans help members stay healthy and manage chronic conditions, as well as how members rate their experience with the plan and its customer service. These ratings incorporate member complaints into the overall rating.

Star Ratings vary by state, county, and plan. In 2021, 97% of Humana’s Medicare Advantage members enrolled in plans rated at least 4 out of 5 stars.

Cost

Medicare health plan costs depend on many factors, including where you live, which type of coverage you want, and what insurance company you choose. The best way to compare specific cost information across insurers in your area is through the plan finder on Medicare.gov, though it helps if you know what type of plan you want.

Humana’s website, on the other hand, lets you compare their Medicare Advantage options with and without prescription drug coverage, as well as Stand-alone Prescription Drug Plans (PDP) in one search.

Monthly premiums are the most obvious costs to consider, and many Medicare Advantage plans have low or $0-dollar premiums. Nearly two-thirds of Medicare Advantage Prescription Drug Plan enrollees paid no premium in 2021, and the average premium for all Medicare Advantage enrollees, including those with and without premiums, is $19 per month for 2022. 

Premiums do not tell the whole cost story. Medicare Advantage plans, with and without prescription coverage, can include copayments, coinsurance, and deductibles. Those other costs can actually outweigh the savings you might have on a $0-premium plan.

Stand-alone Prescription Drug Plan costs include:

  • Humana Walmart Value Rx Plan: This plan has the lowest monthly premium of Humana’s PDP options ranging from $22.70 to $25, with no deductible on Tier 1 and 2 drugs. Copayments for Tier 1 and 2 prescriptions are $1 and $4, respectively, at preferred pharmacies ($10 and $20 copayments at nonpreferred pharmacies). Tiers 3, 4, and 5 include a $480 deductible and coinsurance rather than copayments. 
  • Humana Premier Rx Plan: Premiums range from $68.40 to $86.20, depending on where you live. Tiers 1 and 2 have no deductible; Tiers 3, 4, and 5 have a $480 deductible. Copayments are $1 and $4 for Tiers 1 and 2, respectively, at preferred pharmacies ($5 and $10 copayments at nonpreferred pharmacies). Tiers 1 and 2 also have no copayment for mail-order. Higher copayments apply to Tier 3 drugs, and coinsurance applies to Tiers 4 and 5. 
  • Humana Basic Rx Plan: This plan is best suited for those who qualify for Extra Help, which helps offset medication costs for people with lower incomes. Premiums range from $23.90 to $50.60, depending on where you live. Copayments are $0 and $1 for Tier 1 and 2 drugs, respectively, at preferred pharmacies ($1 and $2 copayments at nonpreferred pharmacies). Tiers 1 and 2 also have no copayment for mail-order. Coinsurance applies to Tiers 3, 4, and 5. There is a $480 deductible for all tiers.

Competition: Humana vs. UnitedHealthcare

Humana and UnitedHealthcare are the Medicare Advantage plans with the broadest geographical coverage; 88% of counties have Humana options, 74% have UnitedHealthcare, and 68% have both. UnitedHealthcare is the nation’s largest health insurer, with more than 14% market share. 

UnitedHealthcare also has an exclusive partnership with AARP, giving it a unique advantage in a trusted brand affiliation. UnitedHealthcare has slightly higher average Star Ratings, but both companies offer online tools or apps and multiple channels for customer support. UnitedHealthcare helps members choose a plan with customized recommendations and cost estimators.

In a head-to-head comparison, the difference may come down to specific quality ratings in your local area and cost, which vary depending on where you are.

 
 Humana
 UnitedHealthcare

Number of States Available 
50
50

Medicare Plans
8
7

Customer Service Options
Telephone, online, in-person, chat (for members)
Telephone, online, in-person, chat

AM Best Rating
A- (Excellent)
A- (Excellent)

Average CMS Star Rating
3.63
3.50

Verdict

Humana has deep roots in care for older Americans. They offer a wide range of Medicare plans in the broadest geography of any insurer. Not only one of the biggest Medicare plans, Humana is one of the highest-rated overall. Not all their subsidiaries score as well for quality or customer satisfaction, so verifying the ratings of your specific options is important.

They also offer a range of ways to sign up and interact with the plan. Humana offers many extra benefits along with health and wellness programs.

Learn More

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How We Reviewed Medicare Providers

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.

Medicare does not offer every plan available in your area. Any information it provides is limited to those plans it offers in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day, 7 days a week to get information on all of your options.