Does Humana Medicare Advantage Cover Dialysis Services?

Understanding your health coverage is critical, especially when dealing with chronic conditions like kidney disease.

This is why we’re taking a deep dive into Humana’s Medicare Advantage HMO plan and answering the question: does Humana Medicare Advantage cover dialysis? Dialysis services are a vital part of treatment for many battling end-stage renal disease, so it’s important to know if your plan covers them.

 

Key Takeaways

 

 

Compare Plans in One Step!

Enter Zip Code

 

 Advertisement

Does Humana Medicare Advantage Cover Dialysis Services?

The world of health insurance can be challenging to navigate, particularly when you need to understand your coverage for managing a chronic condition like kidney disease.

Enter Humana’s Medicare Advantage HMO plan – a comprehensive care package designed to assist individuals with late-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD).

This program provides a multidisciplinary care team to deliver the highest level of care for patients.

 

Decoding Humana Medicare Advantage HMO and Dialysis Coverage

Now, we’ll explore the specifics of dialysis coverage under this plan. Humana’s renal disease management program focuses on providing personalized care objectives and assistance to individuals grappling with kidney disease.

The goal is to help patients live a better quality of life by delivering comprehensive care in partnership with kidney care management firms.

 

Understanding Your Plan Materials

Understanding your health plan materials can seem daunting, but with the right guidance, the specifics of your dialysis coverage become clearer.

The primary elements of Humana Medicare Advantage HMO plan materials include Medicare benefits, prescription drug plans, and supplementary benefits such as dental, vision, hearing, and support services.

To comprehend the specifics of your dialysis coverage, it’s important to pay attention to certain terms such as ‘chronic kidney disease (CKD)’ and ‘end-stage kidney disease (ESKD)’.

The deductibles and co-payments associated with dialysis coverage are subject to variation based on the particular plan, so it’s best to refer to the plan materials or reach out to Humana directly for further details.

 

Home Dialysis Under Humana Plans

Home dialysis is a convenient and comfortable option for many patients, allowing them to receive treatment in the familiar surroundings of their own home.

 

Monogram kidney care clinic

 

 

Humana Medicare Advantage HMO provides coverage for home dialysis for eligible members with chronic kidney disease (CKD) or end-stage kidney disease (ESKD).

Home dialysis under Humana plans offers resources to help manage kidney disease effectively. Specialized services such as in-home primary and specialty care, along with improved care coordination, aim to enhance the healthcare journey of patients undergoing dialysis treatment.

However, the expenses linked to home dialysis may vary depending on the specific plan and coverage, so it’s advisable to directly contact Humana or consult their official website for detailed information on the expenses.

 

In-Center Services: What’s Included?

For those who prefer or require in-center dialysis, Humana’s Medicare Advantage HMO dialysis coverage includes a variety of services. These include:

 

  • Care coordination with the member’s primary care physician and nephrologist
  • In-home health and medication assessments
  • Personalized care management services designed to meet the specific needs of the individual undergoing dialysis

 

These services are part of the resources tailored to provide the best possible care for patients with kidney disease.

In addition to regular dialysis treatments, Humana’s Medicare Advantage plan also provides coverage for emergency dialysis treatments.

Furthermore, the plan covers the cost of medications required during dialysis, ensuring patients don’t have to worry about additional out-of-pocket expenses during their treatment sessions.

Navigating Costs with Humana Medicare Advantage

Healthcare costs can pose a challenge, particularly when dealing with chronic conditions like kidney disease.

However, Humana Medicare Advantage aims to alleviate this burden by introducing strategies that contribute to cost reduction. Value-based care agreements foster preventive care, decrease hospitalization rates, and enhance health outcomes, all of which can lead to significant savings for patients.

To further assist patients in navigating their healthcare expenses, Humana employs renal care coordinators. These professionals play a pivotal role in managing dialysis expenses within Humana Medicare Advantage plans by:

 

  • Collaborating with providers
  • Educating patients on their condition
  • Coordinating care services
  • Ensuring the cost-effectiveness of dialysis treatments.

 

 

The Role of Renal Care Coordinators

 

Esrd humana

Renal care coordinators are an integral part of the Humana Medicare Advantage team.

They are skilled professionals with qualifications in Chronic Kidney Disease (CKD) education and undergo care management training to deliver comprehensive care coordination services.

Their tasks include coordinating treatments, providing education and support, planning care, managing referrals, and conducting monitoring and follow-ups for patients with renal care needs.

They support patients by offering care coordination services, such as collaborating with primary care physicians and nephrologists, conducting in-home assessments, and providing personalized care to improve patients’ health and quality of life while undergoing dialysis treatment.

 

 

Value-Based Care Agreement Benefits

Value-based care is a healthcare delivery model where providers, including hospitals and doctors, are paid based on patient health outcomes. For dialysis patients, value-based care agreements offer numerous advantages, including:

 

  • Cost savings
  • Enhanced patient outcomes
  • Decreased risk of disease progression
  • Heightened accountability
  • Incentives for early intervention

 

Humana’s value-based care agreement benefits dialysis patients through its emphasis on the collaboration and coordination of all facets of their care.

This agreement is designed to enhance patient outcomes and decrease healthcare expenditures for members with chronic kidney disease or end-stage renal disease. The impact of value-based healthcare on the cost of dialysis under Humana plans is significant, potentially reducing costs for both patients and insurers.

 

PPO Members Living with Kidney Disease

For PPO members living with kidney disease, Humana Medicare Advantage offers a range of benefits, including:

 

  • Access to a renal disease management program
  • Care management services tailored for individuals with late-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD)
  • The goal of assisting members in achieving improved health outcomes.

 

PPO members with kidney disease are eligible for a variety of dialysis treatments under Humana Medicare Advantage, including in-home dialysis and other home treatment options, to ensure access to essential renal care.

However, the out-of-pocket expenses for PPO beneficiaries with kidney disease may differ based on the specific plan. Therefore, reviewing plan specifics or directly contacting Humana for details regarding their projected costs for kidney disease-related services, such as dialysis, is essential.

Enhancing Patient Health Outcomes with Humana

Humana’s approach to healthcare places a strong emphasis on improving patient health outcomes. They achieve this through various strategies, including:

 

  • Prioritizing equitable and accessible healthcare
  • Enhancing patient engagement
  • Supporting healthcare practitioners
  • Implementing value-based care approaches
  • Providing customized employee benefits
  • Forming strategic partnerships

 

With these initiatives, Humana is committed to enhancing health outcomes for their patients.

 

Humana forms for providers

 

 

One of the key collaborations that Humana has embarked on to improve patient outcomes is with Interwell Health, a kidney care management company.

Patients with chronic kidney disease can benefit from a wide range of specialized resources including access to 1,700 network nephrologists and in-home virtual support from various healthcare professionals such as dietitians, nurses, and pharmacists. This comprehensive care partnership aims to provide holistic care to patients with chronic kidney disease.

 

High Performing Nephrologists in Network

The quality of care received by a patient often depends on the proficiency of the healthcare provider. In the case of kidney disease, this means access to high-performing nephrologists. Patients receiving care from highly skilled nephrologists within the Humana network can experience advantages such as:

 

  • Comprehensive care
  • Disease management programs
  • Access to specialized expertise
  • Coordinated care

 

The proficiency of in-network nephrologists contributes significantly to the quality of care in Humana Medicare Advantage plans.

They offer specialized care and comprehensive treatment for members with chronic kidney disease, ensuring that members receive the essential medical attention and assistance to effectively manage their condition.

 

Interwell Health Collaboration

Interwell Health is a kidney care management company that has partnered with Humana to provide comprehensive care for patients with chronic kidney disease.

This collaboration provides patients with access to a vast network of nephrologists, renal care coordinators, and in-home virtual support specialists to improve support for the targeted Humana members.

The collaboration is centered on delivering healthcare services to Humana Medicare Advantage HMO and PPO members who are coping with chronic kidney disease (CKD) and end-stage kidney disease. The services offered by the agreement cover residents living in the following states:

 

  • Humana eob Arizona
  • Arkansas
  • Colorado
  • Kansas
  • New Mexico
  • New York
  • North Carolina
  • Ohio
  • Oklahoma
  • Pennsylvania
  • South Carolina
  • Texas
  • West Virginia

 

Members in these states can benefit from the cost sharing agreement’s services.

 

Support Beyond Treatment

Beyond the dialysis treatment itself, Humana provides a renal disease management program designed for members who have late-stage chronic kidney disease (CKD) and end-stage renal disease (ESRD).

This program assists members in establishing personalized care goals and offers support for their kidney disease, helping them to live better with kidney disease live.

The additional assistance provided by Humana for patients undergoing dialysis treatment includes:

 

  • Personalized care goals
  • Support in managing kidney disease
  • Access to care through collaborations with healthcare providers
  • Coverage for out-of-network benefits and supplemental networks
  • Emotional and psychological support
  • Nutritional support

 

These services are designed to provide comprehensive care for patients undergoing dialysis treatment.

Compare plans and enroll online

 

 Advertisement

Speak with a licensed insurance agent

1-833-641-4938
TTY 711

Mon-Fri : 8am-9pm ET

compare medicare advantage plans

Medicare Advantage vs. Original Medicare: A Comparison for Dialysis Patients

A common question among dialysis patients is the difference between Medicare Advantage and Original Medicare, especially in terms of dialysis care. While both types of plans cover dialysis services, they differ in terms of cost structure, benefits, and coverage.

The costs can differ significantly, as Medicare Advantage payments for dialysis services are frequently higher than those of Original Medicare.

The specific payment markups to dialysis organizations by Medicare Advantage plans can lead to increased costs for patients, although the precise total cost implications vary based on the individual’s plan and coverage.

 

The Total Cost Perspective

When considering the total costs related to dialysis treatment, a comparison of both Medicare Advantage and Original Medicare is crucial.

 

Humana provider phone number for claims

 

 

The total costs under Original Medicare can be substantial, amounting to an average annual expenditure of $108,656 per individual in 2017. However, the costs under Medicare Advantage can fluctuate based on the specific plan and coverage.

It’s also important to be aware of any undisclosed expenses linked to dialysis treatment. These may encompass co-pays for related services like:

 

  • lab work
  • outpatient x-rays
  • therapeutic radiology
  • renal dialysis

 

To prevent unexpected costs, thoroughly examining the specifics of your particular Medicare or Medicare Advantage plan is recommended.

 

Access to Specialized Networks

Access to specialized networks can profoundly affect the care of dialysis patients by:

 

  • Enhancing the quality of care
  • Improving patient outcomes
  • Facilitating care coordination
  • Providing self-management support
  • Supporting quality improvement in service delivery.

 

Humana Medicare Advantage provides specialized networks for dialysis patients through agreements with Interwell Health and Fresenius Medical Care North America.

To gain a comprehensive understanding of these networks, it is advisable to inquire directly with Humana or examine the particular plan options available in each state.

 

Customized Kidney Care Management

Customized kidney care management is a crucial aspect of managing kidney disease effectively. In Medicare Advantage, this entails:

 

  • Development of individualized care plans
  • Targeted interventions to maintain the health and well-being of patients at home
  • Emphasis on proactive and tailored support to enhance overall health outcomes.

Humana Medicare Advantage provides personalized kidney care management by:

 

  • Establishing individualized care goals
  • Directing patients towards treatments that suit their lifestyle
  • Offering integrated care options through collaborations and care coordination programs

 

These services aim to enhance outcomes for dialysis patients by delivering care management services, partnering with entities like Monogram Health, and offering the most suitable treatment alternatives, such as home dialysis or kidney transplant.

Geographic Coverage and Accessibility

Geographic coverage and accessibility are key considerations when choosing a Medicare Advantage plan. Humana Medicare Advantage provides dialysis coverage in the following states:

 

  • Alabama
  • Louisiana
  • Mississippi
  • Tennessee
  • Indiana
  • Arizona
  • Arkansas
  • Colorado
  • Kansas
  • New Mexico
  • New York
  • North Carolina
  • Ohio
  • Oklahoma

 

In addition to these states, Humana Medicare Advantage plans are required to provide coverage for the same services for individuals with ESRD as Original Medicare does.

However, potential restrictions on the coverage of dialysis across states with Humana Medicare Advantage should be noted. Therefore, it is advisable to inquire directly with Humana or examine the particular plan options available in each state.

 

State-Specific Plan Options

Humana Medicare Advantage provides dialysis coverage in several states and offers Special Needs Plans (SNPs) for individuals in need of extra support due to chronic or end-stage kidney disease.

However, the variations in Humana Medicare Advantage plan options across different states may encompass differences in:

 

  • Coverage
  • Benefits
  • Costs
  • Network providers

 

Due to these potential discrepancies, it is recommended to:

 

  • Compare the available plan options in your specific state
  • Be aware of any potential restrictions on dialysis coverage across states with Humana Medicare Advantage
  • For a comprehensive understanding of these restrictions, inquire directly with Humana or examine the particular plan options available in each state.

 

Finding a Dialysis Facility in Your Area

Locating a dialysis facility in your area that is within the Humana network is crucial for accessing your benefits and managing your kidney disease effectively. If you need to find a dialysis facility under Humana Medicare Advantage HMO, you can use the ‘Find a doctor’ tool on Humana’s website.

 

Humana pain management guidelines

 

 

Humana Medicare Advantage plan members are also provided with resources including:

 

  • The renal disease program
  • REACH Kidney Care nurses
  • Pharmacists
  • Dietitians
  • Care management services

 

These resources are designed to assist in finding appropriate dialysis facilities and managing their chronic kidney disease or end-stage renal disease.

Summary

In conclusion, Humana’s Medicare Advantage HMO plan offers comprehensive coverage for dialysis services, with a focus on improving patient outcomes and reducing healthcare costs.

Through strategic collaborations, value-based care agreements, and a network of skilled nephrologists, Humana strives to provide high-quality care to patients battling chronic kidney disease.

Whether you prefer home dialysis or in-center services, Humana’s plan aims to cater to your specific needs. However, it’s crucial to understand your plan materials, consider the total costs, and verify the network of providers in your area to ensure you’re making the most of your coverage.

Frequently Asked Questions

 

 

How much does dialysis cost with Medicare for seniors?

The cost of hemodialysis and peritoneal dialysis with Medicare for seniors varies. It is best to consult with Medicare for specific cost details.

 

What insurance covers dialysis?

Most people starting dialysis can get coverage for their health care costs through Medicare, Medicaid, or private insurance plans, usually after a three-month waiting period. Consider checking these options for coverage.

 

Do Medicare Advantage plans cover kidney transplants?

Yes, Medicare Advantage plans cover kidney transplants according to Part A and Part B coverage, including inpatient and outpatient care related to the transplant. If there’s a problem with the care or referral, individuals have the right to file a complaint (grievance).

 

What is the recent value-based care agreement established between Humana and Interwell Health?

The recent value-based care agreement between Humana and Interwell Health aims to improve health outcomes for patients and reduce the overall cost of care on a large scale.

 

In which states does Humana Medicare Advantage provide dialysis coverage?

Humana Medicare Advantage provides dialysis coverage in Alabama, Louisiana, Mississippi, Tennessee, Indiana, Arizona, Arkansas, Colorado, Kansas, New Mexico, New York, North Carolina, Ohio, and Oklahoma. This coverage is not available in all states.

call today for help

 

 

 ZRN Health & Financial Services, LLC, a Texas limited liability company

Find & Compare Plans Online 

 

 Advertisement

Speak with a licensed insurance agent

 1-833-641-4938
TTY 711

Mon-Fri : 8am-9pm EST

Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.