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Home > Help > Frequently Asked Questions > Medicare Prescription (Part D) Drug Plans
FAQs
Costs
Coverage
General
Q. What is the Humana Prescription Drug benefit?
Medicare contracts with insurance companies, including Humana, to offer prescription drug plans (PDPs). If you’re considering a PDP, please keep the following in mind:
- Optional plan. A PDP is an option – not a requirement. However, if you don’t join a PDP when you become eligible, you’ll have to pay a higher premium if you join later.
- Monthly premium. PDPs have a monthly premium in addition to the Medicare premium you already pay. However, some Medicare Advantage plans, including some of Humana’s, have prescription drug coverage included as a benefit without an additional monthly premium.
- If you’re already enrolled in a Medicare Advantage plan, you may be covered. If you’re enrolled in a Medicare Advantage plan, such as an HMO through a private insurance company, you may already have prescription drug coverage. If that’s the case, choosing a separate PDP isn’t necessary – in fact, getting the PDP would cancel your Medicare Advantage coverage.
- Benefits and costs. PDP plan benefits vary, but companies offering these plans are required to offer certain minimum benefits. Humana’s PDP benefits are equal to, or better than, these required minimums.
Q. What prescription drug plans does Humana offer?
Humana offers three types of Medicare prescription drug plans; Standard, Enhanced, and Complete. Each plan provides different levels of benefits depending on your needs and the premium you’re most comfortable with.
Q. When does the Medicare prescription drug coverage begin?
If you sign up for a prescription drug plan during the annual election period – November 15 through December 31 – your coverage begins on January 1 of the following year. If you sign up outside of the annual election period, your coverage begins on the first day of the month after Humana receives your completed application – unless you request a later effective date.
Q. Do I really need a prescription drug plan?
The answer depends on your medical and financial situation. Think about your needs and what’s important to you. Keep in mind the costs of prescriptions are high and expected to increase. A prescription drug plan may help control your expenses. Remember, if you were eligible to join Medicare Part D and did not do so, you’ll have to pay a penalty for joining the plan later and that penalty increases with each month that passes.
Q. What if I did not select a plan by December 31?
You may have to pay a penalty for signing up late unless you qualify for one of these exceptions:
- You didn't become eligible for Medicare until after December 31
- You became eligible for a “limited income subsidy” after December 31
To find out if you qualify for a limited-income subsidy or extra help, go to the Social Security Administration (SSA) Website, www.ssa.gov, or call the SSA Monday through Friday, 7 a.m. to 7 p.m., at 1-800-772-1213. If you have a speech or hearing impairment and use a TTY, call 1-800-325-0778.
If you missed the deadline and don’t qualify for an exception noted above, you may have to pay a penalty of one percent of the national average premium for every month you’re late. You pay the penalty for as long as you have the plan.
Q. Is it better to enroll in an all-in-one plan that provides both medical and drug coverage?
The answer depends on your personal preferences and budget. For many people, the main reasons for choosing a Medicare Advantage plan are: (1) the simplicity of dealing with one company and (2) additional benefits and services not available with Original Medicare. For others, the choice comes down to price. In some areas, the all-in-one plan is less expensive than prescription coverage alone. To make your decision, it might help to add up what you spend now and what you’d spend with a Medicare Advantage plan. For example:
| What I have now |
My annual costs |
With the Medicare Advantage plan I'm considering |
My annual costs |
| Medicare Part B premium |
$ |
Medicare Part B premium |
$ |
| Prescription drug premium |
$ |
Medicare Advantage premium |
$ |
| Medicare Supplement Plan premium |
$ |
Estimated out of pocket costs - visit the Plan Comparison page on this Website and use the "My Annual Costs" feature |
$ |
| Fitness center membership |
$ |
|
$ |
| Out of pocket costs |
$ |
|
$ |
| Total= |
$ |
Total= |
$ |
Costs
Q. Can Humana prescription drug Plans help me save on the costs of prescriptions?
Humana's Rx Calculator SM tool can help you get an idea of what your monthly drug costs will be. To use the Rx Calculator, go to the Plan Choices section at the bottom of this page and enter your ZIP Code in the box. Choose the My Rx Coverage button on the My Available Plans screen and then click the Rx Calculator link.
Q. How much will my Humana prescription drug plan cost?
Humana offers three different Medicare prescription drug plans: Standard, Enhanced, and Complete. Each plan has its own levels of coverage and premium costs. For an on overview of each plan’s benefits and costs, go to the Plan Choices section at the bottom of this page and enter your ZIP Code in the box.
Q. Does a Humana prescription drug plan make sense for someone who takes only a few prescriptions each month?
Most people with Medicare currently need, or will come to need, prescription drugs to stay healthy. So, even if you don’t need many prescription drugs now, choosing a prescription drug plan today can protect you from high out-of-pocket costs later. Also, if you don’t sign up for drug coverage when you’re first eligible but decide to enroll later, you may have to pay more each month – at least one percent more for every month you wait.
Q. How do I pay my premiums?
In addition to the monthly Medicare Part B premium to Medicare, you pay a plan premium to the insurance company that provides your coverage. Humana offers several ways to pay, including automatic deduction from your Social Security check or the option to receive a bill in the mail.
Q. Which Humana prescription drug plan has the lowest premiums?
Premiums vary depending on the type of plan and where you live. You can compare plans and their premiums here based on where you live by entering your Zip Code at the bottom of the page.
Q. What if I need help paying for prescription drugs?
Extra help is available for people with limited income and resources to help pay for their healthcare and prescription drug costs. To find out whether you qualify, contact the Social Security Administration (SSA) at 1-800-772-1213, 24 hours a day, 7 days a week. TTY Users: 1-800-325-0778 from 7 a.m. - 7 p.m. EST or visit www.ssa.gov.
Q. How do I find my current drug costs?
Go to MyHumana, your personal, password-protected page on Humana.com and select the "Rx CalculatorSM" link or "Drug Pricing" tool link. Your individual pharmacy claims will be listed by year.
Coverage
Q. What is the “coverage gap”?
In some plans, if your costs reach an initial coverage limit, then you pay 100% of your prescription drug costs. This is called the coverage gap. This "gap" in coverage is generally above [$2,510 (in 2008)] in total drug costs until you spend [$4,050] out-of-pocket. Some plans might offer some coverage during the gap. Even in plans where you pay 100% of covered drug costs after a certain limit, you would still pay less for your prescriptions than you would without this drug coverage.
Q. Are both brand-name and generic drugs covered under Humana’s plans?
Yes, but not all brand name and generic drugs are covered. You should verify that your drugs are part of Humana’s approved drug list before enrolling in one of our plans.
Though your costs for generic drugs are usually lower than your costs for brand-name drugs. The Food and Drug Administration (FDA) requires generic drugs to have the same quality, strength, purity, and stability as brand-name drugs.
Q. How can I find out which drugs are covered?
Humana’s Medicare Prescription Drug List (formulary) can show you which drugs are covered with each plan.
Q. What is a formulary?
A formulary is a list of prescription medications approved for coverage by a health plan.
Q. How often does the Drug List change?
Humana updates the Drug List at least once a year, at the beginning of the year. However, medications on the Drug List can be added, changed, or deleted from the list at any time. For instance, we may move a brand-name drug to a different category when a generic equivalent becomes available. We alert members to upcoming Drug List changes in SmartSummary Rx SM, the personalized prescription drug plan statement Humana sends to members each month.
Q. What if a medication I’m already taking is not “preferred” on the Drug List?
Humana will cover a one-time, temporary supply of your current drug. After that:
- If the Drug List includes other drugs that treat the same condition, Humana requires you to try those drugs before we cover the drug you already take. For example, if Drug A and Drug B both treat your medical condition, Humana may not cover drug B unless you try Drug A first. If Drug A does not work for you, Humana will cover Drug B. This process is called “Step Therapy.”
- If no other options are available on the Drug List, your doctor must obtain approval from Humana before we cover the prescription. This process is called “Prior Authorization.”
Q. Are insulin and diabetic supplies covered by Humana’s prescription drug Plans?
No, but diabetes self-monitoring supplies – including glucose monitors, test strips, lancets, and screening tests – are covered under Medicare’s medical benefits rather than prescription drug benefits. With Original Medicare, you pay 20 percent of Medicare-approved amounts after a deductible. Medicare Advantage and Medicare Supplement plans provide additional coverage for insulin and diabetic supplies beyond what Original Medicare covers.
Q. Do I need a Humana prescription drug Plan if I already receive prescription drug coverage as part of my employer's retiree benefits?
Probably not. If you or your spouse has, or is able to get, employer group coverage, talk to your employer to find out how your benefits will be affected if you join a Humana prescription drug plan. Get this information before you decide to enroll in the plan.
Q. What is “creditable coverage”?
This term means the plan offers at least the basic benefits required by Medicare. Any plan can offer more benefits, but the law states no plan can offer less.
Q. I have coverage through Veterans Affairs (VA). Will my prescriptions continue to be covered??
As long as you still qualify for TRICARE, Veterans Affairs (VA), or the Federal Employee Health Benefits Program (FEHB), your drug coverage did not change with the introduction of the Medicare Part D plan. Contact your benefits administrator or your FEHB insurer before making any changes to your coverage. It will almost always be to your advantage to keep your current coverage without any changes.
If you lose your TRICARE, VA, or FEHB coverage and join a Medicare Part D plan after May 15, 2006, in most cases you won’t have to pay a penalty as long as you join within 63 days of losing TRICARE, VA, or FEHB coverage.
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