Thursday, June 6, 2024

Is Humana Gold A Medicare Advantage Plan

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Pros And Cons Of Medicare Coverage From Humana

Humana Gold Choice Medicare Advantage – Should You Enroll?

As with most plans, there are both pros and cons to opting for Humana.

As far as cons go, while the insurance company itself is available all over the country, certain plans may not be.

For example, SNPs are available in just 20 states and there are additional limitations on the type of condition covered like the state of Georgia, which technically has SNPs, but only for diabetes.

For the pros, one major advantage for Humana is its status as a national company with availability across the U.S. This can offer more security than you might get from a more regional option and ensures that some form of coverage is likely available where you live.

Another pro is that, with some exceptions, Humanas customer satisfaction tends to be high. A 2022 J.D. Power Medicare Advantage study ranked Humana in second place for overall plan satisfaction.

About The Humana Drug List

The Humana Drug List contains the most widely prescribed drugs covered by Humana. The formulary is updated by doctors and pharmacists on a regular basis as new medications are introduced or others are removed. Updates to the current formulary are posted monthly.

Humana Medicare Advantage plans that offer prescription drug coverage may use a tiered drug list, which means that less expensive medications on a lower tier may be covered with lower copayments, coinsurance or deductibles.

Your Humana Medicare Advantage plan drug list might include coverage guidelines such as the following:

  • Generic drugs may often be on a lower tier with lower out-of-pocket costs.
  • Name-brand drugs may be on a higher tier with higher copayments, coinsurance or deductibles.
  • Depending on which plan you have, some Humana Medicare Advantage plans with prescription drug coverage may require you to visit a pharmacy that is in the plan network.
  • Some plans may allow you to visit pharmacies outside of the plan network, but your out-of-pocket costs could potentially be higher.

Not every Humana Medicare Advantage plan offers prescription drug coverage, and plan coverage and benefits may vary based on your location.

Cheapest Medicare Advantage Provider: Cigna

  • Average monthly cost: $7

Cigna offers cheap prices for Medicare Advantage plans, and its PPO plans are an especially good value, costing only $2 per month on average.

Pros and cons of Cigna


  • Affordable coverage with many options that have no monthly cost
  • Very cheap PPO plans that are a good value for those who want flexibility and have moderate medical needs
  • Several no-deductible plans, which give you low-cost medical care from day one of the policy


  • Poor customer service
  • Plans with a high spending cap can mean high costs for those who need surgery or ongoing medical treatment

Full details about Cigna Medicare Advantage

Cigna’s Medicare Advantage plans stand out for those who are looking for affordable coverage. Most plans are available for no monthly cost on top of what you pay for Original Medicare.

Even though Cigna’s average cost of $7 per month is the same as Wellcare’s, Cigna has a much higher rating from with an average of 3.6 stars versus Wellcare’s rating of 2.8. This means that Cigna’s plans are a much better choice for low-cost coverage that also has good customer satisfaction and a network of high-quality medical providers.

Although existing Cigna customers are as satisfied with their plans as customers who have Humana or AARP/UHC, a key downside of Cigna’s Medicare Advantage is the company’s customer service. With just 2.8 stars for its customer service, policyholders likely face some frustrations when calling their insurance company.

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What Are Humana Medicare Advantage Plan Options

Humana offers nearly a dozen plans, including HMOs, PPOs, PFFS plans, and SNPs. Some plans dont have monthly premiums and have relatively affordable out-of-pocket costs, with visits to primary care doctors ranging from $0 to $15 and visits to specialists from $20 to $45. In addition to covering medical and hospital care, all plans include memberships for SilverSneakers, and many have an allowance for over-the-counter medications. Plans vary depending on your location. Check available options in your area.

These are among the most popular Humana Medicare Advantage Plans:

Humana Medicare Advantage Plans

*Based on pricing in Chicago, IL in 2022

Humanas Value Plus H5216

Advantages and Disadvantages of the Humana Gold Plan

Overall, Humana Value Plus H5216-197 is rated four stars, which is the highest possible rating. These factors are used to generate the star rating. It receives a four-star rating from the Health Benefit Rating . This primary care rating has a 4 star rating. The network received a four-star rating in the ratings. The Value Rating has an average rating of 4 stars. The four-star rating reflects Humanas commitment to providing high-quality care to its members, which is why this plan is a good value for money. When it comes to deciding whether to join a Medicare Advantage plan, youll need to consider the benefits and cost savings available from Humana Value Plus H5216-197.

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Humana Hmo Medicare Advantage: The Best Way To Save On Medical Expenses

There are many medical supply stores that accept Humana HMO Medicare Advantage. This type of Medicare Advantage plan is a great option for those who want to save money on their medical supplies and prescriptions. The plan offers a wide variety of benefits, including discounts on medical supplies, prescription drugs, and vision care.

What Is Better Hmo Or Ppo

If you have lower medical costs and dont mind using a physician to manage your care, an HMO may be right for you. If you already have a doctor or medical team on retainer but do not belong to your plan network, you may benefit from a PPO.

The Pros And Cons Of Ppos

The primary reason that a PPO is so popular is that it balances the ease of implementation, the complexity of sampling, and the ease of tuning, attempting to compute an update at each step to minimize the cost function while preserving the small deviation from the previous policy. A PPOs lower monthly premiums, as well as the possibility of out-of-network coverage in the event of an emergency, are two of its benefits. The downside of a PPO is the possibility of higher premiums if you go out of network and meet the deductible requirement before services are provided.

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Ability To Use Doctors Or Hospitals Outside Of Network

HMO plans generally require you to use doctors or hospitals in your network. PPO plans allow you to go outside of your network, but the cost may increase. PFFS plans let you go outside of your network if the doctor or hospital accepts the payment terms and agrees to treat you, and SNPs* generally require you to stay in your network.

Humana Medicare Advantage At A Glance

2022 Humana Medicare Advantage | Humana
  • Plan options: Humana offers a wide range of Medicare Advantage plan options that cater to a variety of beneficiaries, including HMOs, PPOs and SNPs.
  • Provider network: The number of providers varies based on where you live. For example, there are 127,000 doctors contracted with Humana in northeastern Wisconsin.
  • Average monthly premium: Humana offers a number of plans with $0 monthly premiums. The average premium, however, is $19 per month.

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Humana Medicare Advantage Service Area

Humana offers Medicare Advantage plans in 49 states and Puerto Rico, and Medicare prescription drug plans in all 50 states, Washington, D.C., and Puerto Rico. Humana Medicare Advantage plans are available in 91% of U.S. counties the most of any provider.

For the 2023 plan year, Humana expanded its HMO offerings into 260 new counties and introduced local PPO plans in 260 new counties. The company also expanded D-SNPs into 184 new counties

What Is Humana Medicare Advantage

Medicare Advantage plans, also known as Medicare Part C, cover a broader set of benefits than Part A and Part B together do. A Part C plan from Humana:

  • Covers everything that Original Medicare covers
  • Typically offers benefits that go beyond traditional Medicare
  • Comes with a cap on out-of-pocket costs for the year
  • May include Part D prescription drug benefits as well

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Is Humana Medicare Supplement An Hmo

The Humana Gold Plus HMO plans provide lower monthly premiums or no premiums at all, as well as coverage that provides more benefits than Original Medicare and ensures that your annual deductible is not exceeded. Health Maintenance Organizations provide Medicare Advantage plans to approximately 60% of Medicare Advantage plan members.

Humana Gold Plus H1036

Humana Advantage

Humana Gold Plus H1036-054C H1036-054-000 is a 2021 Medicare Advantage plan with drug coverage provided by Humana.

When it comes to cost-sharing, youll want to consider both monthly costs and out-of-pocket costs. This plan has a monthly premium of $0.00, which covers both the health and drug portions of the plan.

When it comes to out-of-pocket costs for drugs, this plan has a Part D drug Deductible of $0.00 and an Initial Coverage Limit of $9500. This plan also notably provides extra coverage in the coverage gap phase, meaning your insurer will pay a greater share of costs for covered drugs than the standard amount required by Medicare. Each drug tier may be subject to different cost-sharing in each coverage phase, so keep that in mind when considering out-of-pocket costs. Check out the drug formulary below for more information, or reach out to a licensed Medicare agent for help using the call number on this page. Alternatively, if you know what plan you want, you can enroll online yourself using our site as well.

Plan Basics

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Humana Medicare Advantage Plans Review

Are Humana Medicare Advantage Plans a good fit for you?

Quick Humana Medicare Advantage Plans Review
Humana has a wide selection of highly-rated Medicare Advantage Plans with positive customer reviews, including HMO, PPO, SNP, and PFFS plans.
Medicare rating: 4 stars A.M. Best financial strength rating: A- BBB rating: A+ NCQA rating: 3.5 to 4 stars Consumer Affairs rating: 3.8 J.D. Power ranking: 4th out of 10

Humana, a healthcare insurance company, is headquartered in Louisville, Kentucky. The company has received awards for its products, customer services, and business practices, and it receives consistently positive reviews from policyholders. Humana has a wide selection of Medicare Advantage Plans, some with varying out-of-pocket expenses, so researching your options is essential for finding a plan thats right for you.

Humana Walmart Value Rx Plan

Under the Humana Walmart Value Rx Plan, Humana teams up with Walmart, Walmart Neighborhood Markets, and Sams Club pharmacies as its preferred cost-sharing partners.

This lets Humana offer additional prescription savings to people who purchase their medications at Walmart.

The Humana Walmart Value Rx Plans benefits include:

  • $17.20 monthly plan premium nationwide
  • $0 deductible on tier 1 and 2 medications
  • $445 annual deductible on tiers 3 through 5 medications
  • in-store copays as low as $1 on a 30-day supply of certain generic drugs at Walmart, Walmart Neighborhood Markets, and Sams Club
  • copays as low as $3 on a 90-day supply of tier 1 preferred generics through Humanas mail-delivery pharmacy
  • more than 3,500 medications on the plans list of covered drugs

Before choosing the Humana Walmart Value Rx Plan, make sure you live near a Walmart location that features pharmacy services. While you are able to use other pharmacies under this plan, you wont get additional discounts if you dont use Humanas preferred cost-sharing partners.

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Find The Best Medicare Advantage Plan For You

Everyone has different health needs. Be sure to look up your plans network, costs and its list of covered drugs before making your decision. By taking the time to research and compare , you can find the one that benefits you the most.

* SNPs can be any type of MA plan such as an HMO or PPO.

Explore Medicare

Medicare Advantage Company With The Largest Network: Blue Cross Blue Shield

Humana Medicare Advantage Your Journey Starts Here | Humana
  • Average monthly cost: $38

Consider Blue Cross Blue Shield if you want the strength of an established insurance company and the flexibility of a large network of doctors and medical providers.

When comparing provider networks, keep in mind that it’s not always an apples-to-apples comparison because each company publicizes its figures slightly differently. However, the overall trends can give you a snapshot of how broad the health care access could be in your area.

  • BCBS/Anthem: 90% of doctors and hospitals
  • Cigna Healthspring: 1.5 million health care providers, clinics and facilities
  • UnitedHealthcare/AARP: 1.3 million health care providers
  • Aetna/CVS: 1.2 million health care providers
  • Humana: 560,000 providers in the ChoiceCare and Behavioral Health networks
  • Centene: 238,000 physicians
  • Kaiser Permanente: 80,000 physicians and nurses

Pros and cons of BCBS


  • Inconsistent benefits and customer satisfaction rates because each BCBS subsidiary operates independently

Full details about BCBS Medicare Advantage

BCBS has one of the largest provider networks, making it a good choice for those who are seeking flexibility about which doctors and medical facilities they use.

Whether BCBS is operating in your area as Anthem, Highmark or another subsidiary, the company’s massive footprint can give you access to one of the industry’s largest provider networks.

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Whats The Best Way To Compare Medicare Advantage Plans

When comparing Medicare Advantage plans, there are two main things to consider: cost and coverage. For cost, consider the total amount that you’ll pay for health care and insurance. In some cases, you’ll get a better deal by paying more for a policy that has better benefits, helping you to save on health care. For coverage, make sure a plan gives you strong benefits in the areas you expect to need the most, such as diabetes care, prescription drugs or inpatient surgery.

Whats Typically Not Covered By Medicare

When it comes to Medicare, there are a few exceptions that are common to the system. Long-term care is typically defined as care provided for more than 12 months. Home health care, physical therapy, and chiropractic care are examples of services not covered by Medicare. This is not always the case, though. Those who receive nursing home care or hospice care may receive special treatment. If long-term care is an essential component of long-term care, nursing home care is usually covered. Hospice care is usually covered by health insurance companies if it is regarded as an essential component of palliative care.

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Humana Medicare Advantage Members In Florida Will Have Access To New Dental Benefits In 2023 Including Higher Annual Allowances Of Up To $6000 That Can Be Used For Out

October 21, 2022 – Humana is expanding 2023 dental benefits under its Medicare Advantage plans in Florida and will offer members access to a more extensive provider network and higher annual allowances.

HumanaFloridas largest Medicare Advantage plan by membershipoffers health maintenance organization plans, preferred provider organization plans, and special needs plans .

Were thrilled to announce a significant investment in our dental benefits and network, Caraline Coats, Humanas South Florida Medicare President, said in the press release. In our 30-plus years of serving Medicare members in Florida, weve learned a lot about what is important to our members, and dental care is a top priority and, of course, important to ones overall health.

Dig Deeper

Starting in 2023, Florida residents enrolled in a Humana HMO or PPO Medicare Advantage plan can access the Florida GoldPlus Dental Network. This network includes 8,100 dentists across Florida and a nationwide network, allowing members to seek in-network care in and outside the state.

The payer is also expanding coverage for dental procedures and increasing flexibility on how to pay for services, according to Coats.

For example, most 2023 plans will include benefits covering major services, such as periodontal scaling. In addition, annual allowances have increased to $6,000 for select plans.

Worst Medicare Advantage Plans: Wellcare/centene

Humana Medicare Pharmacy List

The worst Medicare Advantage plans are from Wellcare because it has a low overall rating of 2.8 stars, and existing policyholders give their medical plans just 1.9 stars. Plans may be cheap, averaging only $7 per month, but other major Medicare companies offer low-cost plans that also have better ratings.


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Examining The Eligibility Requirements For The Humana Gold Plus Medicare Advantage Plan

In order to qualify for the Humana Gold Plus Medicare Advantage Plan, you must meet certain eligibility requirements. To be eligible, you must be enrolled in both Medicare Part A and Part B and live in the plans service area. You must also not have End-Stage Renal Disease . In addition, you must not be enrolled in a Medicare Supplement plan.

If you meet the eligibility requirements, you can apply for the Humana Gold Plus Medicare Advantage Plan. To apply, you can visit the Humana website or contact Humana directly. Once your application is approved, you will receive a membership card and a welcome packet with information about your coverage.

Available Humana Medicare Advantage Plans

Humana offers several kinds of Medicare Advantage plans, and they vary in structure, costs and available benefits. Many plans offer dental and vision benefits, worldwide emergency care, and fitness benefits through SilverSneakers.

In general, Humana offers Medicare Advantage prescription drug plans, or MAPDs, as well as stand-alone prescription drug plans and Medicare Advantage plans without drug coverage. And Humana and USAA have partnered to offer the Humana USAA Honor with Rx plan, another plan in the Humana Honor family, which is aimed toward U.S. military veterans.

Other plan offerings include the following types:

A Medicare 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.

Medicare 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 dont need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

Humanas private fee-for-service plans allow you to see any Medicare-approved provider who accepts your Humana plan. You wont have to pick a primary doctor, and you wont need a referral to see a specialist.

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