FAQs
Medicare Advantage Plans
- Which Medicare Advantage plans does Humana offer?
- Do Humana's Medicare Advantage plans include prescription drug coverage?
- How can I enroll in a Humana Medicare Advantage plan?
- What are the dates for enrollment in Medicare plans?
- Are Humana's Medicare Advantage plans available in my area?
- A specialist I want to see is listed in your provider directory. Does that mean I can see that specialist if I am an HMO member?
- What if I'm hospitalized?
- If I'm traveling and need emergency care, am I covered?
- How can I find out which services are covered by the plan I'm most interested in?
- Can my membership in Humana's Medicare Advantage plans be cancelled by the plan?
- Do I have to take a physical examination when I enroll in a Medicare Advantage plan?
Q. Which Medicare Advantage plans does Humana offer?
Humana offers a range of Medicare Advantage plans to fit most every need: Medicare Advantage Health Maintenance Organization (HMO), Medicare Advantage Preferred Provider Organization (PPO), and Medicare Advantage Private Fee-for-Service (PFFS).
Medicare Advantage plan (HMO) is an alternative to Original Medicare and features specific lists of doctors, hospitals, and other providers you must use to have your healthcare covered. HMOs often provide additional benefits not found in Original Medicare, including coverage for deductibles, a drug benefit plan, and wellness or fitness programs. A Medicare Advantage HMO is an alternative to Original Medicare coverage. However, you can return to Original Medicare down the road if you wish. How Humana's HMO plans work.
With a Medicare Advantage plan (PPO), you can see any doctor you want. However, if you use a doctor who is in the network, you get a better benefit and lower co-payment than if you visit a non-network doctor. Plus, referrals aren't needed, and you don't have to see a primary care physician first. Besides prescription drug benefits, Medicare Advantage PPOs may offer other benefits like dental, vision, and nutritional supplements. A Medicare Advantage PPO is an alternative to Original Medicare coverage. However, you can return to Original Medicare down the road if you wish. How Humana's PPO plans work.
With a Medicare Advantage plan (PFFS), you have the freedom to select any Medicare doctor, hospital, or healthcare provider who accepts Humana's payment terms and conditions, without worrying about referrals or seeing only doctors on a list. PFFS plans feature limits on out-of-pocket expenses, coverage for emergency and urgent care, and in most cases, a prescription drug benefit. A PFFS plan is an alternative to Original Medicare coverage. However, you can return to Original Medicare down the road if you wish. How Humana's PFFS plans work.
Q. Do Humana's Medicare Advantage plans include prescription drug coverage?
Most Humana Medicare Advantage plans include prescription coverage. In some areas of the United States, Humana offers Medicare Advantage plans that do not include prescription drug plans. To find out which options are available to you, enter your ZIP code. You'll see a chart that shows the plans you can choose from, with an overview of their benefits and costs.
Q. How can I enroll in a Humana Medicare Advantage plan?
Once you've entered your ZIP code and viewed your available plans on the "My Available Plans" page, you can simply click the "Enroll" button for the plan of your choice. You will then continue to enrollment. To enroll online, you'll need information from your Medicare card or your letter from the Social Security Administration or Railroad Retirement Board, so keep those handy. If you need assistance you can always call us at the number either on the top or bottom of our Website.
Q. What are the dates for enrollment in Medicare plans?
Here are key enrollment dates:
October 15 – December 7, 2012 (Annual Election Period)
If you're eligible, you can enroll in Medicare health benefits, such as a Medicare Advantage plan, for the following year. During this period, you can also change plans or enroll in a separate prescription drug plan.
Medicare Enrollment and Eligibility Information
Q. Are Humana's Medicare Advantage plans available in my area?
You can easily find which Humana plans are available in your area. From the home page, look for the "Compare & Enroll" section and type in your ZIP code. Or you can enter your ZIP code at the bottom of most pages, including this one. You'll see a chart that shows the plans you can choose from, with an overview of their benefits and costs.
Q. A specialist I want to see is listed in your provider directory. Does that mean I can see that specialist if I am an HMO member?
In most cases, if you are a Humana member enrolled in a Medicare Advantage HMO (Health Maintenance Organization) plan, your Primary Care Physician (PCP) decides which specialists he or she refers patients to. Generally, primary care physicians will have established relationships with certain specialists they prefer to work with. So you'll need to check with your PCP about the specialist you would like to see. Please remember, you can't see a specialist listed in the directory without a referral from your PCP except in the case of emergency, urgently needed care, or out-of-area kidney dialysis.
Q. What if I'm hospitalized?
Coverage for hospitalization varies, depending on the plan you select. For instance, some Medicare Advantage plans have a set copayment per day, while others have a set amount per hospital stay. For details on hospitalization coverage, enter your ZIP code in the Plan Choices section at the bottom of this page. You'll see a chart that shows the plans you can choose from, with an overview of their benefits and costs. You also can download the Plan Benefit Summary for additional information.
Q. If I'm traveling and need emergency care, am I covered?
With any Humana Medicare Advantage plan, you're covered for emergency care - wherever you are. You do NOT need a referral from a primary care physician or authorization from Humana to receive emergency services. Actual coverage amounts vary by plan. For details on emergency coverage, enter your ZIP code in the Plan Choices section at the bottom of this page. You'll see a chart that shows the plans you can choose from, with an overview of their benefits and costs. You also can download the Plan Benefit Summary for additional information.
Q. How can I find out which services are covered by the plan I'm most interested in?
The online tools and resources on Humana-Medicare.com make it easy to find the benefits and services associated with each plan. From the Website's home page, use the "Compare & Enroll" feature to view detailed information about all the plans available in your area.
Q. Can my membership in Humana's Medicare Advantage plans be cancelled by the plan?
Humana can't cancel your coverage because of your age or health. You may be involuntarily disenrolled from the plan only under the following circumstances:
- You permanently move out of the service area and fail to notify us. (A permanent move includes an absence of more than six consecutive months.)
- Your Medicare Part A or Medicare Part B coverage ceases.
- You knowingly commit fraud or permit misuse of your membership card.
- You are disruptive, unruly, abusive, or uncooperative for reasons unrelated to your medical condition and your behavior prevents treatment to you or other members (disenrollment for cause). We must receive prior approval from CMS for this type of disenrollment.
- Our contract with CMS is terminated or the service area is reduced.
- You fail to pay any monthly plan premium.
Q. Do I have to take a physical examination when I enroll in a Medicare Advantage plan?
No. Except for the limitations listed below, you are guaranteed acceptance into Humana's Medicare Advantage plans, regardless of your age or the status of your health.
- The plan must be open for new enrollments.
- You must live within the plan's service area.
- You must be entitled to Medicare Part A and enrolled in Part B. If you are enrolled in Part B only, you must purchase Part A from the Social Security Administration.
- You cannot have end-stage renal disease. Federal law will not allow us to accept anyone who has end-stage renal disease (kidney failure), unless you: (1) have had a successful kidney transplant or no longer need regular dialysis, or (2) are a member of another health plan offered by us within the same service area, or (3) were a member of a Medicare+Choice plan that was terminated or discontinued after December 31, 1998, and this is your first election following that plan termination or discontinuance.