Humana Medicare Review

Humana Health Insurance Ratings at a Glance

You’re eligible to sign up for Medicare 3 months before you turn 65, during your birthday month and 3 months after. If you don’t sign up during this short window of time, you could pay a late penalty which will be added to your monthly premium. 

Once you’ve enrolled in Medicare, you can sign up for a Medicare Advantage plan offered by a private insurer. Humana is an insurance provider that offers a wide range of Medicare Advantage plans, some with $0 monthly premiums.

Learn more about how you can work with Humana to find your Medicare Advantage plan.

What is Medicare?

Medicare is a federally funded insurance program geared toward U.S. citizens 65 and older. It’s also available to individuals with disabilities under the age of 65 who receive Social Security Disability benefits. To qualify for Medicare, you must have contributed to Medicare taxes throughout your lifetime. 

Medicare is divided into 4 parts:

• Part A covers inpatient hospital stays, skilled nursing facilities and some in-home care.
• Part B covers outpatient doctor visits, specialty and therapy care, and durable medical supplies.

Parts A and B are known as Original Medicare.

• Part C, also called a Medicare Advantage plan, is offered by private insurance companies. But there are still benefits provided by Original Medicare such as dental and vision coverage.
• Part D is prescription drug coverage not covered by Original Medicare. Some Medicare Advantage plans include drug coverage. You can also buy standalone Part D plans from private insurers to complement an Original Medicare plan.

Another plan to consider is a Medicare Supplement or Medigap plan. Medicare Supplement plans, offered by private insurance companies, are meant to fill in the gaps of Original Medicare. 

Medicare Advantage plans are regulated by the Centers for Medicare and Medicaid Services (CMS), a federal agency. CMS sets guidelines for insurers to follow regarding plan offerings, services, rates and marketing practices. Plans that violate CMS guidelines are subject to suspension, fines or termination.

CMS also rates plans with stars from 1 to 5, with 5 being the highest. Star ratings are based on areas such as provider choice, performance, plan features and pricing. 

You can sign up for a Humana Medicare Advantage plan if:

• You are about to turn 65, it's your 65th birthday month or it's within 3 months after your birthday.
• You collect Social Security Administration disability benefits. In this case, you might be under the age of 65.
• You or your spouse are seeking a Medicare Advantage plan.
• You will soon turn 65 but are still working. You can can choose a Medicare Advantage employer group plan but still have to pay your Medicare Part B premium and any copays or deductibles that apply.

In all of these cases, you must have paid Medicare taxes and be a U.S. citizen.

Medicare Advantage Plans Offered by Humana

Here's a breakdown of the Medicare Advantage plans offered by Humana.

• Health Maintenance Organization (HMO) plans: HMO plans consist of regional networks of doctors, specialists and hospitals who are contracted to charge established rates and copays for care. You’ll need to choose a primary care doctor for referrals to see specialists. You must stay within your Humana’s HMO network. If not, you’ll pay full price for services. HMOs promote health and wellness, so you’ll receive incentives and rewards to maintain a healthy lifestyle. HMO plans offer medications, walking programs, diet and nutrition resources and smoking cessation plans.  
• Preferred Provider Organization (PPO) plans: PPO plans cost more than HMO plans but include more benefits. For example, you can see any doctor you like but will pay less if you choose within Humana’s network. PPO plans are also more flexible. No referrals are needed if you want to see a specialist. PPOs are made up of large networks of hospitals and providers who’ve agreed to charge predetermined rates for services. If you choose a provider or hospital outside of the PPO network, you’ll pay more.
• Medicare Supplement or Medigap plans: Humana offers Medicare Supplement plans that cover many out-of-pocket expenses not paid for by Original Medicare.
• Special Needs plans (SNP): SNP plans combine all the benefits of Original Medicare, including prescription drug coverage, but are only available to people who have an additional qualifying condition, such as chronic health conditions or live in a long-term care facility.
• Part D or prescription drug plans: These are standalone plans that complement Original Medicare or Medicare Advantage plans.

Pricing and Value

You can easily compare Humana’s Medicare Advantage plans. Visit Humana' website and provide basic info such as your city and ZIP code. You can also compare plans using Medicare’s find-a-plan tool at www.medicare.gov.

Here are a few examples to give you an idea of what it offers:

Some of these plans offer vision and dental coverage for an additional monthly fee as well as free fitness programs. These rates are estimates and may vary based on your income, health status, age and other factors, so check with a licensed sales agent to learn more.

Customer Service

Humana offers several options to reach customer service representatives including:

• Visit humana.com
• Chat with an online representative or virtual assistant
• Call 800-457-4708

Humana’s website is also a great resource for:

• Estimating the cost of a health service
• Locating a doctor or pharmacy
• Filing a claim or checking a claim status
• Reviewing your balance
• Changing your coverage
• Checking your plan details
• Ordering a replacement or additional ID card
• Accessing your benefits and services
• Reviewing their Frequently Asked Questions section

Claims Support

Generally, your doctor, specialist or hospital will file a claim with Humana, but in some cases, you might have to file a claim yourself. If a provider doesn’t take your insurance or can’t verify your coverage, you may need to submit a claim and request reimbursement.  Or if you receive care while traveling outside the U.S. you will need to file a claim. 

To file a claim you can fill it out and mail it or file it online. You can check the status of your claim by phone or by logging in to your member account. 

In addition to reviewing information from Humana and Medicare.gov, there are other sources you can look to when considering Humana’s Medicare Advantage plans. Humana’s GoldPlus HMO plan in Tennessee was named among its 2019 Best Insurance Companies for Medicare Advantage, a study that considers CMS star ratings, prescription drug coverage, pricing and plan features. 

Humana was ranked 2nd in the J.D. Power 2022 Medicare Advantage Study. The study rates plans on overall satisfaction, customer service, billing and payment, provider choice, coverage and benefits, communication and cost. Most of Humana’s ratings in the studies were “Better Than Most” and “Among the Best.”  

Other Facts to Know About Humana:

• 97% of Humana’s Medicare Advantage members are enrolled in 4-star and above plans for 2022.
• More recently, Humana received J.D. Power’s Best for Customer Service award in 2022.

Researching Medicare Advantage plans isn’t any different than researching a big purchase such as a house or car. The Medicare plan you choose impacts your health and budget for years, so it makes sense to take your time and weigh your options. 

Humana offers plans worth considering, but many other plans offer competitive benefits. Decide which benefits are most important and enroll in the best plan for your needs.

Frequently Asked Questions