Humana Dual Eligible Special Needs Plans 2025
For people who qualify for both Medicare and Medicaid, there are several options available. One of them in 2025 is Humana Dual Eligible Special Needs Plans.
This concise article provides vital information on enrollment, benefits, and costs to guide your decision-making process. Expect clear insights into plans designed for individuals dual-eligible for Medicare and Medicaid.
Key Takeaways
- Humana’s 2025 D-SNPs maintain consistent enrollment processes with previous years, cover varied regional needs, and offer an array of additional benefits, including dental, vision, hearing, and in-home support services for dual-eligible individuals.
- Costs for Medicare Part B and specific plan premiums apply to enrollees of Humana’s D-SNPs, with Optional Supplemental Benefits (OSB) available at an extra premium, and $0 copays on certain prescriptions to reduce out-of-pocket expenses.
- Humana integrates Medicare and Medicaid benefits to manage both efficiently for dual-eligible individuals, aiming to reduce care fragmentation, with a commitment to diversity and inclusion in their services and policy compliance.
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Understanding Humana’s Dual Eligible Special Needs Plans for 2025
As an organization offering Medicare Advantage HMO, PPO, and PFFS along with prescription drug plans, Humana presents a multitude of D-SNPs for 2025, designed with a keen understanding of the needs of dual-eligible Medicare beneficiaries.
These plans vary across different regions, reflecting the unique requirements of each area.
Enrollment Process and Eligibility Criteria
The enrollment process for Humana’s D-SNPs remains consistent with previous years, making it straightforward for potential enrollees.
Interestingly, in 2021, a notable growth was observed with nearly 29% of dual-eligible individuals being enrolled in D-SNPs, marking a significant rise since 2010.
Plan Options and Coverage Areas
Choice is a significant factor when it comes to healthcare. For dual-eligible individuals, over 90% lived in a county that offered at least one D-SNP in 2022, with an average person being able to choose from 10 different D-SNPs.
The plans offered vary significantly by state, as illustrated by the enrollment rates ranging from 5% in Nevada to 58% in Hawaii in 2021. In some states like CA, CT, DC, DE and South Dakota, the availability of D-SNPs may also differ.
To provide an example, in Tennessee, while D-SNPs offer benefits, TennCare does not guarantee the availability or quality of these benefits.
Humana’s Cleveland Clinic Preferred HMO and D-SNP plans in Ohio reflect an effort to provide quality provider networks, including a variety of in-network ancillary providers and pharmacies for enrollees.
Premiums and Out-of-Pocket Costs
Grasping the costs associated with healthcare plans is a vital step in making informed decisions. Enrollees of Humana’s plans are responsible for paying their Medicare Part B premium as well as the premium for their specific Humana plan.
For added benefits, enrollees may choose to pay for Optional Supplemental Benefits (OSB), which require a separate premium payment.
Enhanced Benefits Tailored for Dual Eligibles
Beyond basic healthcare coverage, Humana’s 2025 D-SNPs offer a broader spectrum of services. They come with comprehensive coverage options including dental, vision, and hearing, alongside additional benefits like over-the-counter items, meal benefits, safety devices, and in-home support services.
Dual-eligible beneficiaries enrolled in Humana’s D-SNPs enjoy cost-saving advantages such as $0 copays on prescriptions and a Healthy Options Allowance that can be used for various essentials, with the convenience of month-to-month rollover of unused funds.
Additionally, members can avail themselves of virtual visit services for remote consultations with healthcare providers.
Optional Supplemental Benefit Inclusions
Opting for Humana’s Medicare Advantage plans means enjoying covered preventive dental services like exams and cleanings without additional costs. But the dental coverage doesn’t stop there.
Many of Humana’s Medicare Advantage plans include additional dental coverage extending beyond basic preventive care.
Access to Lower Cost Preferred Pharmacies
Humana’s D-SNP plans to make medication access more affordable. The plans include a range of lower-cost, preferred pharmacies. Plus, Humana Medicare Advantage plans with prescription drug coverage offer $0 copays for Tier 1 and Tier 2 prescriptions at preferred mail-order pharmacies for a three-month supply.
However, it’s worth noting that these lower costs may not be available at all pharmacies, so it’s recommended to consult the online pharmacy directory or call customer service for up-to-date information.
Humana’s customer service team also offers support to D-SNP members, including assistance with understanding network pharmacies and accessing preferred cost-share pharmacies in their area.
Free Language Interpreter Services
Healthcare should remain accessible, regardless of language barriers. That’s why Humana offers free language interpreter services to ensure accessibility for all members. These services include assistance in a variety of languages, helping non-English speaking members to effectively communicate with healthcare providers.
This provision exemplifies Humana’s compliance with federal civil rights laws, prioritizing linguistic inclusivity.
Coordinating Medicare and Medicaid
A distinguishing feature of Humana’s D-SNPs is their capacity to integrate Medicare and Medicaid benefits. This coordination manages both sets of benefits for dual-eligible individuals.
Humana has coordinated care plans that hold a contract with both Medicare and state Medicaid programs, facilitating the coordination of services. However, the effectiveness of benefit coordination with Medicaid for providing a comprehensive range of benefits is still being evaluated.
Understanding Coordination of Benefits
The coordination of benefits within Humana’s D-SNPs ensures that dual-eligible individuals receive all the benefits they are entitled to from both Medicare and Medicaid without duplication or coverage gaps.
These assistance programs for dual-eligible individuals are designed to comply with both Medicare and state Medicaid program requirements, which are key for the proper coordination of benefits.
Overcoming Barriers to Care
Healthcare shouldn’t be a puzzle for patients to solve. For dual-eligible beneficiaries, integrated care experiences like Humana’s D-SNPs simplify the complexity of navigating multiple systems of care.
Models like D-SNPs aim to address the disproportionate impact of chronic conditions and fragmented care experienced by dual-eligible beneficiaries.
Quality of Service and Provider Networks
Humana’s D-SNPs place a strong emphasis on the quality of service. Integrated delivery models for dual-eligible beneficiaries rely on adequate access to primary care.
However, primary care workforce shortages can pose a significant barrier to effective integrated care delivery for dual-eligible beneficiaries, potentially limiting the expansion and effectiveness of D-SNPs.
To counter this, Humana demonstrates a commitment to provider network quality by including a diverse range of providers in their network, as well as ancillary services such as labs and medical equipment suppliers.
Commitment to Diversity and Inclusion
Humana’s dedication to diversity and inclusion goes beyond mere verbal commitments. This is evident in the actions of the company’s CEO, Bruce Broussard, who visibly champions diversity and inclusion by participating in initiatives like the CEO Action for Diversity & Inclusion and the Catalyst CEO Champions for Change.
Humana fosters a culture of inclusion that is considered a fundamental asset, underpinned by organizational values of caring, curiosity, and commitment.
The Executive Diversity, Equity, and Inclusion Council at Humana ensures that principles of diversity and equity are woven into the very fabric of the company.
Non-Discrimination Policies
At the heart of Humana’s commitment to equitable healthcare services lies its non-discrimination policies. The policies ensure that individuals are not excluded or treated differently based on various factors such as:
- national origin
- age
- disability
- marital status
- military or veteran status
- religion
This demonstrates a commitment to equality and fairness in all interactions.
For those facing language barriers, free language interpreter services are provided. These services are an integral component of Humana’s adherence to federal civil rights, reinforcing their efforts to provide non-discriminatory service to all members.
Support for Varied Demographics
Healthcare should be accessible and accommodating to diverse populations, and Humana’s D-SNPs are designed with this in mind.
Navigating Legal and Policy Changes
Keeping pace with the evolving landscape of healthcare legislation and policies can pose challenges. Recent changes to Medicare Advantage plans include increased oversight of network adequacy and updates to the risk adjustment model.
Healthcare legislation has also introduced new criteria for D-SNP plans, requiring them to form stronger partnerships with state Medicaid programs. These laws mandate that D-SNP plans have at least one formal agreement with the state’s Medicaid agency to streamline services and benefits.
The potential impacts of the expiration of the Coverage Gap Discount Program include:
- Increased out-of-pocket costs for medications within D-SNPs
- Necessity for plan adjustments to accommodate the changes
- Potential modifications in Humana’s plan infrastructure to align with new CMS rules regarding interoperability and patient access.
Updates on Medicare Advantage Regulations
The 2025 final rule for Medicare Advantage includes provisions intended to create better alignment between MA and Traditional Medicare. To clarify these changes, CMS released FAQs to clarify coverage criteria and utilization management for Medicare Advantage plans.
Increasing program oversight is a key provision in the 2025 final rule for Medicare Advantage, aiming to ensure quality and alignment with Traditional Medicare standards.
The American Hospital Association calls for rigorous enforcement of the new rules and further clarification to ensure Medicare Advantage plans, including each Medicare advantage plan, comply.
Impact of Health Care Legislation
The COVID-19 pandemic has elevated the importance of integrated healthcare strategies for Medicare and Medicaid, particularly in regions with a substantial dual-eligible population.
Adjustments in scope-of-practice laws at a state level may be a strategic response to improve the primary care access issues faced by dual-eligible beneficiaries.
The AHA’s advocacy for greater Medicare Advantage oversight suggests the possibility of policy changes that could influence Humana’s D-SNPs.
CMS’s initiative to gather public input on Medicare Advantage modifications reflects an ongoing review process that could shape future structuring of D-SNPs like those offered by Humana.
Staying Informed: Resources and Support
Humana values the need to keep its members up-to-date and well-supported. This is reflected in their strong emphasis on offering customer support to D-SNP members to help them make informed decisions regarding their healthcare.
They provide a specific customer service number for D-SNP members, which is 1-800-281-6918, with TTY assistance available at 711.
Through this customer support, D-SNP members can receive detailed information about their plans, get answers to their queries, and obtain guidance on how to maximize their benefits.
Customer Support and Assistance Programs
Humana provides a gamut of customer support and assistance programs, including:
- Home delivery of medications through CenterWell Pharmacy, with $0 copays for 90-day supplies of Tier 1 and Tier 2 medications
- Virtual visit healthcare and prescription services
- State-specific information on limitations via remote technology to ensure compliance with regulations in different states.
Educational Materials and Workshops
To empower its D-SNP members, Humana provides a wealth of educational materials, reinforcing the adage that knowledge is power.
These materials include comprehensive information about the D-SNP members’ network providers and pharmacy directories. The informational design of the materials aids D-SNP members in making informed decisions regarding their healthcare plans.
Furthermore, Humana’s educational resources emphasize the importance of understanding potential limitations, particularly of virtual visit healthcare and prescription services accessed remotely.
Summary
Humana’s Dual Eligible Special Needs Plans for 2025 stand as a testament to the company’s commitment to providing comprehensive coverage and benefits to dual-eligible individuals. From offering a diverse range of plan options to ensuring the coordination of benefits between Medicare and Medicaid, these plans promise a seamless healthcare experience.
The commitment to diversity and inclusion, along with the efforts to navigate legal and policy changes, further strengthens Humana’s position as a leading healthcare provider.
Frequently Asked Questions
→ What is new for Humana 2025?
In 2025, Humana’s Medicare Advantage plans all offer dental, vision, and hearing benefits, along with a $0 monthly plan premium and coverage that coordinates with VA health care. These plans also provide access to specially trained Humana Customer Care specialists.
→ What is a dual special needs plan D SNP?
A dual special needs plan (D-SNP) is a type of Medicare Advantage plan tailored to meet the needs of individuals who are eligible for both Medicare and Medicaid.
These plans offer specialized care, care coordination, and additional services.
→ Who has the best Medicare Advantage plans for 2025?
In 2025, the best Medicare Advantage plans are offered by Humana, UnitedHealthcare, Aetna, and Blue Cross Blue Shield based on factors like overall quality, network size, extra perks, local support, and low-cost plan availability.
Humana stands out for high plan quality, wide availability, and free plan options, making it a top choice for Medicare Advantage.
→ How does Humana coordinate Medicare and Medicaid benefits?
Humana coordinates Medicare and Medicaid benefits through its D-SNPs, which provide integrated care coordination and manage both sets of benefits for dual-eligible individuals.
They hold contracts with both Medicare and state Medicaid programs to facilitate the coordination of services.
→ What does Humana’s commitment to diversity and inclusion look like?
Humana’s commitment to diversity and inclusion is seen through its non-discrimination policies and provision of free language interpreter services, ensuring equitable healthcare services for all members regardless of various factors.
ZRN Health & Financial Services, LLC, a Texas limited liability company
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.