Humana is the second-largest provider of Medicare Advantage plans , and the provider that’s available to the most people, with plans offered in more than 8 out of 10 U.S. counties. Most of its Medicare Advantage customers are in high-quality plans rated 4 stars or higher by the Centers for Medicare & Medicaid Services, and the company offers some nice perks with many plans.
Although most of Humana’s Medicare beneficiaries are in high-rated plans, some contracts get lower scores on customer satisfaction than others, so it’s worth doing your research before you sign on.
Here’s what you should know about Humana Medicare Advantage.
Humana Medicare Advantage pros and cons
Humana’s offerings have advantages and disadvantages:
Most widely available: With plans available in 2,703 U.S. counties (or 84%), Humana is an option for more Americans than any other provider.
Quality plans: Although Humana has plans with lower star ratings from the CMS, the provider has 15 contracts rated 4 stars or higher (out of 5) that include 92% of its existing Medicare Advantage members.
COVID-19 perks: Humana offers $0 copays for COVID-19 testing, and for members with a COVID-19 diagnosis, there’s a $0 copay for treatment and 14 days of home-delivered meals.
Access to a top-rated mail-order pharmacy. Ordering your regular prescriptions for mail delivery can save money, and Humana Pharmacy tops the list in customer satisfaction, according to J.D. Power .
Special needs plans aren’t available everywhere: Currently, Humana’s Dual-Eligible SNPs are available in about half of U.S. states (26), and the company’s Chronic Condition SNPs are available in only 12 states .
Mixed reviews: Although J.D. Power ranked Humana third-highest Medicare Advantage insurer in its 2020 member satisfaction study, a number of plans were ranked 3.0 or below out of 5 by the National Committee for Quality Assurance.
Humana Medicare Plans
Available Medicare Advantage plans
Humana offers several kinds of Medicare Advantage plans, and they vary in terms of structure, costs and benefits available. Many plans offer dental and vision benefits, worldwide emergency care, and fitness benefits through SilverSneakers.
In general, Humana offers Medicare Advantage Prescription Drug Plans as well as stand-alone Prescription Drug Plans and Medicare Advantage Plans without drug coverage. It’s also worth noting that Humana Honor, the company’s Medicare Advantage plan that’s aimed toward U.S. military veterans, has been expanded into 46 states in its second year of operation.
Other plan offerings include the following types:
A health maintenance organization generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.
Preferred provider organization plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.
Humana’s private fee-for-service plans allow you to see any Medicare-approved provider who accepts your Humana plan. You won’t have to pick a primary doctor, and you won’t need a referral to see a specialist.
Special needs plans restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Humana offers two types of SNPs:
Chronic Condition SNP: For people with one or more of these conditions:
Chronic heart failure.
Chronic lung disorders.
Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.
Available Part D prescription drug plans
While many of Humana’s Medicare Advantage plans include Medicare Part D drug coverage, the company also sells stand-alone Part D prescription drug plans. These plans are meant to accompany Medicare Part A and Part B and do not provide medical coverage.
Humana offers three stand-alone prescription drug plans in 2021, with average monthly premiums that range from $17.20 to $72.50:
Humana Walmart Value Rx Plan: Monthly premium of $17.20, costs as low as $1 copay and $0 deductible on Tier 1 and Tier 2 drugs, and access to a wide network of pharmacies, including but not limited to Walmart.
Humana Premier Rx Plan: Monthly premium of $58.30 to $72.50, costs as low as $0 copay and $0 deductible on more than 900 Tier 1 and Tier 2 drugs, and a broad network of pharmacies.
Humana Basic Rx Plan: Monthly premium of $19.70 to $45, prescription deductible of $445 on all tiers. This plan is aimed at members who qualify for Extra Help, who may be able to get the full cost of premiums covered. Extra Help is a Medicare program that offers assistance to people with limited income and resources.
Humana Medicare Advantage offers most members access to routine vision and dental coverage. Many of its plans offer other benefits as well. Here are a few standouts:
If you’re recovering from an inpatient stay at a hospital or skilled nursing facility, or you’re enrolled in a qualified chronic condition SNP, you can receive home delivery of a certain number of meals.
About half of Humana’s Medicare Advantage Prescription Drug Plans and a third of its Part D plans offer this benefit that helps members pay less for diabetes medications.
All members of Humana’s Dual-Eligible Special Needs Plans have access to a Healthy Foods Card, which provides members a monthly allowance of up to $75 to purchase approved healthy food and beverages.
Some plan members may get an allowance they can put toward over-the-counter items like cough and cold meds, first-aid supplies, vitamins and pain relievers.
All Medicare Advantage members get $0 telehealth copays for visits with a primary care doctor, urgent care, and outpatient behavioral health.
As mentioned above, Humana members can take advantage of $0 copays for COVID-19 testing, and for members with a COVID-19 diagnosis, there’s a $0 copay for treatment and 14 days of home-delivered meals.
Humana members can contact their plan’s customer service in the following ways:
Humana Medicare Advantage service area
Humana offers Medicare plans and Medicare prescription drug plans in all 50 states, Washington, D.C., and Puerto Rico, and the company offers Medicare Advantage plans in 46 states and Puerto Rico. In all, Humana Medicare Advantage is available in 84% of counties — the most of any provider . Eighty-seven percent of Medicare beneficiaries have the option of a Humana plan.
For the 2021 plan year, Humana expanded its HMO offerings into 125 new counties and introduced local PPO plans in 98 new counties.
Overall, Humana is the fourth-largest health insurer in the country , and it is the second-largest among for-profit health plans . Nearly 4.5 million Medicare beneficiaries are enrolled in a Humana Medicare Advantage plan , and the company added 369,000 new members for the 2021 plan year.
Costs for Medicare Advantage plans will depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium, and Humana has expanded its offerings of $0-premium plans. In 2021, the company estimates that almost 6 out of 10 of its members are in $0-premium plans that offer care coordination services and enhanced benefits not offered under Original Medicare.
Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is at least $148.50 in 2021. (Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay more.)
Other out-of-pocket costs to consider include:
Whether the plan covers any part of your monthly Medicare Part B premium.
The plan’s yearly deductibles and any other deductibles, such as a drug deductible.
Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.
The plan’s in-network and out-of-network out-of-pocket maximums.
Whether your medical providers are in-network or out-of-network, or how often you may go out-of-network for care.
Whether you require extra benefits, and if the plan charges for them.
To get a sense of costs, use Medicare’s Plan Finder to compare information among available plans in your area. You can select by insurance carrier to see only Humana plans, or compare across carriers. You can also shop directly from Humana’s website by entering your ZIP code, and you’ll be able to compare the plans available.
Medicare star ratings
Average Star Rating: 3.7
The Centers for Medicare & Medicaid Services maintain its own database of star ratings on every Medicare Advantage and separate Medicare Part D plan, ranging from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year. You can find a plan’s rating with the Medicare Plan Finder.
Based on the most recent year of data, Humana’s Medicare Advantage plans get an average rating of 3.6, and the company’s prescription drug plans (Part D) get an average score of 3.8. The overall average score for Humana’s plans is 3.7 . For comparison, the average star rating for plans from all providers was 4.06 .
That said, Humana notes that 92% of its Medicare Advantage members who are in rated contracts (4.1 million people) are in contracts with 4 stars or more in 2021 . Three Medicare Advantage contracts received 4.5 stars, and one contract — CarePlus Health Plans Inc. — received 5 stars and covers approximately 164,300 members. There were also 12 Humana contracts that were too new to be measured.
To get an overall star rating, the CMS ranks contracts on 46 plan factors. Here’s where Humana plans really delivered, with average scores of 4.5 (out of 5) and above:
Adult BMI assessment (checking to see if members are at a healthy weight).
Care for older adults – medication review (yearly review of all medications and supplements being taken).
Care for older adults – functional status assessment (yearly assessment of how well plan members are able to do activities of daily living).
Care for older adults – pain assessment (percent of plan members who had a pain screening at least once during the year).
Complaints about the health plan (more stars mean fewer complaints).
Reviewing appeals decisions (fairness of the plan’s appeal decisions, based on an independent reviewer).
Foreign language interpreter and TTY availability (availability of teletypewriter services and foreign language interpretation when prospective members call the plan).
Complaints about the drug plan (more stars mean fewer complaints).
MPF price accuracy (plan provides accurate Medicare Plan Finder drug pricing information for the website).
In some categories, Humana contracts averaged a sub-3.0 score:
Breast cancer screening (percent of female plan members ages 52 to 74 who had a mammogram in the past two years).
Annual flu vaccine (percent of plan members who got a flu shot).
Improving or maintaining physical health (percent of plan members whose physical health was the same or better than expected after two years).
Osteoporosis management in women who had a fracture (percent of female members who broke a bone and got screening or treatment for osteoporosis within six months).
Improving bladder control (percent of members with a urine leakage issue in the past six months who talked about treatment options with a provider).
Rating of health plan (member’s rating on a scale of 0 to 100).
There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included three here:
A.M. Best is a credit rating agency that specializes in the insurance industry. In August 2020, A.M. Best affirmed its Financial Strength Rating of A- (Excellent) for the majority of health insurance subsidiaries of Humana Inc. .
A.M. Best also affirmed an FSR of A- for Humana’s dental subsidiaries, and affirmed an FSR of B++ (Good) for Humana Insurance of Puerto Rico Inc. and Humana Health Plans of Puerto Rico Inc., which are Humana subsidiaries.
An A- rating in this category indicates that A.M. Best believes Humana has an excellent ability to meet its ongoing insurance obligations. (The two subsidiaries with a B++ rating are deemed to have a “good” ability to meet ongoing insurance obligations.)
In its 2020 U.S. Medicare Advantage Study — the sixth it’s done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. On these measures, Humana scored 806 points out of 1,000 and came in third out of the top 10 Medicare Advantage providers .
The National Committee for Quality Assurance rates health insurance plans on a 5-point scale (with 5 being best) based on clinical quality, member satisfaction and results from the NCQA Accreditation Survey. The ratings highlight the results of care and what patients say about their care.
In its 2019-2020 ratings of Humana plans (there were no ratings in 2020), NCQA awarded ratings between 4.0 and 2.0, with the bulk receiving 3.5, 3.0 or 2.5 ratings . The top rated plans with scores of 4.0 were Cariten Health Plan Inc., Humana Benefit Plan of Illinois Inc. and Humana Medical Plan Inc. of Florida. One plan — Humana Insurance Company of Florida — received a 2.0 rating, with low scores on customer satisfaction and prevention, a category that indicates how well plans provide preventive services.
Find the right Medicare Advantage plan
It’s important to do your research before selecting a health plan for yourself. Here are some questions to consider asking:
What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?
Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.
Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs in, and are there any coverage rules that apply to them?
Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?
Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?
If you have additional questions about Medicare, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227, TTY 877-486-2048).