Humana Medicare Advantage Plans California 2025
Navigating the realm of healthcare can be complex, especially when it comes to selecting the right Medicare Advantage plan. With a myriad of options available, how do you choose the one that best aligns with your needs?
Humana, a renowned health insurance provider, offers a variety of Humana Medicare Advantage plans in California 2025. In this comprehensive review, we aim to guide you through these plans, helping you understand not only their features but also how they compare to other providers in the market.
Key Takeaways
- Humana’s Medicare Advantage plans in California for 2025 include diverse options like HMO, PPO, and SNP plans, with an emphasis on managed care, flexible provider choices, and special care for chronic diseases or dual eligibility individuals.
- Members must consider premiums, deductibles, copays, coinsurance, out-of-pocket maximums, and additional charges for benefits when choosing a plan, with many Humana plans offering a $0 premium option and varying costs for in-network and out-of-network services.
- In addition to medical service coverage, Humana’s plans offer prescription drug coverage, dental, vision, and supplemental benefits with potential access to preferred pharmacy pricing, and additional services and wellness programs for a comprehensive healthcare package.
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Overview of Humana Medicare Advantage Plans in California for 2025
Humana’s Medicare Advantage plans in California for 2025 offer a diverse range of options, enabling beneficiaries to find the plan that best suits their healthcare needs.
These options encompass Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Special Needs Plans (SNP) options.
The different types of Medicare Advantage plans, including Medicare Advantage HMO PPO options, are:
- HMO plans: These plans focus on providing members with a wide network of healthcare providers and promoting effectively managed care.
- PPO plans: These plans offer flexibility, allowing members to visit any Medicare-approved physician.
- SNP plans: These plans are tailored to individuals with specific diseases or characteristics, such as those with chronic conditions or dual eligibility for Medicare and Medicaid.
HMO Plans
Humana’s HMO plans, also known as Humana Health Plan, prioritize coordinated care and offer the following benefits as part of their Humana Medical Plan, including the Humana USAA Honor Plans:
- A network of doctors, hospitals, and other healthcare providers to manage all aspects of a member’s healthcare
- Lower monthly premiums and out-of-pocket costs
- An annual maximum out-of-pocket cost limit
This financial protection can be further enhanced by using lower-cost preferred pharmacies.
Members who opt for a Humana HMO plan gain the advantage of selecting a primary care physician from an extensive network and receiving coverage for routine dental, vision, and hearing care, benefits that Original Medicare doesn’t typically include.
PPO Plans
Humana’s PPO plans offer an added degree of flexibility. They allow members to visit any Medicare-approved physician, whether they are in Humana’s provider network, as long as they accept Medicare.
This means no referral is necessary to consult with a specialist. Specialist visits are covered by Humana’s PPO plans, requiring a copay that ranges from $40 to $90.
Keep in mind, that seeking services from providers outside of Humana’s PPO network could result in higher out-of-pocket expenses and possible balance billing from the provider.
Despite this, Humana’s Medicare Advantage PPO Plans in California for 2025 provide comprehensive coverage, including dental, vision, and hearing, and are expected to have an average premium of just $18.50 per month.
SNPs
Special Needs Plans (SNPs) are specifically designed for individuals with certain diseases or characteristics. Humana offers Chronic Condition SNPs for individuals with conditions like diabetes mellitus, cardiovascular disorders, chronic heart failure, or chronic lung disorders, and Dual-Eligible SNPs for individuals entitled to Medicare and eligible for assistance from a state Medicaid program.
These plans provide customized benefits and assistance to address the specific health requirements of individuals with chronic conditions or dual eligibility for Medicare and Medicaid. Do bear in mind that these plans may not be available in all locations.
Comparing Costs: Premiums, Deductibles, and Out-of-Pocket Expenses
When selecting a Humana Medicare Advantage plan in California, one must consider various costs, including:
- Copayments
- Coinsurance
- Deductibles
- Coverage of the monthly Medicare Part B premium
- In-network and out-of-network out-of-pocket maximums
- Supplementary charges for additional required benefits
Approximately 63% of Humana’s Medicare Advantage plans will offer a $0 premium in 2025. However, potential enrollees are required to pay the minimum monthly premium for Medicare Part B, which amounts to $174.70 in 2025.
$0 Premium Plans
A $0 premium plan means there is no monthly fee for the plan. However, participants usually still need to pay the Medicare Part B premium, which includes medical services and doctor visits in states like MD, ME, MI, MN.
Eligibility for Humana’s $0 premium Medicare Advantage plans in California is contingent upon various factors, such as:
- Medicare and Medicaid eligibility
- Residency in an area where Humana offers Dual-eligible Special Needs Plans (D-SNPs)
- Meeting Humana’s specific requirements for these plans.
Copays and Coinsurance
In Humana’s Medicare Advantage Plans, copays represent predetermined amounts that members are required to pay for services, such as primary care visits.
This amount may differ depending on the plan, while coinsurance represents a proportion of the expenses for covered services that members are accountable for, such as 20% for doctor services or hospital outpatient services.
Copays are occasionally applicable to fundamental services like preventive exams, telemedicine, and pharmacy services in Humana Medicare Advantage Plans. Coinsurance is generally necessary for services such as hospitalization, outpatient services, and other medical expenses that are not covered by fixed copays.
Out-of-Pocket Maximums
Out-of-pocket maximums serve as a cap on spending for covered services. Once a member surpasses this limit within a planned year, they are no longer required to make payments for any covered services exceeding that threshold.
These maximums provide substantial financial protection by limiting the annual cost-sharing that a participant may be responsible for. This encompasses deductibles, copayments, and coinsurance for in-network services.
The out-of-pocket maximums for Humana Medicare Advantage Plans in California for 2025 typically range around $4,835 for in-network services and $8,659 for a combination of in-network and out-of-network services.
Prescription Drug Coverage and Pharmacy Networks
Humana’s Medicare Advantage plans in California for 2025 include:
- Prescription drug coverage, although there are limitations and restrictions
- Mandatory use of network pharmacies
- Possibility of encountering a Coverage Gap or ‘donut hole’ that enforces a temporary limit on what the plan covers
Humana’s preferred pharmacies can be located using their Pharmacy Finder tool online, where simply entering your ZIP code or Humana member ID allows you to identify in-network retail pharmacies in your area.
Preferred Pharmacies
Preferred pharmacies, such as CenterWell Pharmacy, collaborate with Humana Medicare Advantage Plans to provide prescriptions at a reduced cost through special cost-share options for medications.
Utilizing a preferred pharmacy with a Humana Medicare Advantage Plan can result in decreased copays and minimized out-of-pocket expenses, offering substantial savings on medications. These pharmacies can provide lower prescription costs due to their special pricing agreements negotiated with Humana.
You can verify if a pharmacy is preferred under your Humana Medicare Advantage Plan by consulting the Humana website’s pharmacy directory or by contacting Humana customer support for help.
Stand-Alone Prescription Drug Plans
Humana’s stand-alone prescription drug plans offer fundamental coverage for prescription medications and provide access to a preferred mail-order cost-sharing pharmacy.
Humana offers three stand-alone Medicare prescription drug plans in California for 2025: the Humana Walmart Value Rx, Humana Premier Rx Plan, and Humana Basic Rx Plan. The costs of these plans differ based on the plan and coverage.
Unlike the stand-alone prescription drug plans, Humana’s regular Medicare Advantage plans offer coverage for both medical services and prescription drugs.
Dental, Vision, and Additional Benefits
Humana Medicare Advantage plans in California may provide optional supplemental benefits such as dental coverage. These plans encompass preventive dental services, including annual exams, two complimentary cleanings per year, and dental X-rays once every 5 years.
In addition, Humana Medicare Advantage plans in California do provide vision coverage, which may encompass an annual allowance for eyeglasses frames and prescription lenses, as well as prescription contact lenses.
Furthermore, Humana Medicare Advantage plans in California provide supplementary benefits, including:
- an allowance for eligible groceries
- over-the-counter products
- utilities
- rent
This extends coverage beyond Original Medicare with additional perks for military veterans, ensuring equal access regardless of national origin age disability.
Dental Coverage
All Humana Medicare Advantage Plans in California for 2025 encompass preventive dental services, including annual dental exams, teeth cleaning, and whitening.
These plans offer a wide range of dental services, encompassing routine dental exams, cleanings, fillings, tooth extractions, and dental X-rays.
Furthermore, Humana Medicare Advantage plans do provide coverage for orthodontic procedures.
Vision Coverage
All of Humana’s Medicare Advantage plans in California for 2025 include vision coverage, distinguishing them by offering coverage for annual eye exams, eyeglass frames with prescription lenses, and prescription contact lenses, unlike other Medicare Advantage Plans in the state.
Eye exams are a covered benefit under Humana Medicare Advantage Plans in California. Certain Humana Medicare Advantage plans in California offer coverage for prescription eyewear, encompassing eyeglasses or contact lenses.
Humana Medicare Advantage Plans provide discounts on a range of vision services such as eyeglass frames and lenses, lens enhancements, and Lasik.
Additional Benefits
Humana Medicare Advantage Plans encompass various wellness initiatives, well-being and rewards program, Sharecare for health and wellness management, and the SilverSneakers health and fitness program, which provides complimentary membership to local gyms and fitness centers as part of the fitness program benefit.
Members of Humana Medicare Advantage Plans are eligible for an over-the-counter allowance which can be utilized for the purchase of qualifying non-prescription items, along with a range of health and wellness products.
The telehealth services benefit offered by Humana enables beneficiaries of the Medicare Advantage Plan to access health care for minor illnesses or behavioral health issues through video-conference appointments from the comfort of their homes, making it a valuable addition to their Medicaid services.
Ratings and Reviews: How Humana Compares to Other Providers
Humana’s Medicare Advantage Plans have garnered positive reviews and high ratings. The average star rating for Humana’s 2025 Medicare Advantage plans is 4.34, surpassing the national average of 4.04.
Furthermore, 92% of Humana’s Medicare Advantage members in rated contracts are in contracts with 4 stars or more, representing the highest percentage of members in 4+ star contracts among all national health plans.
The member satisfaction rating for Humana is 3.97, which exceeds the industry average, and it outperforms the industry average in customer satisfaction in numerous significant Medicare markets, as reported by J.D. Power.
Financial Strength
AM Best assesses the financial strength of insurance companies using a scale that spans from A+ to D. Humana’s financial strength is rated as excellent by AM Best, indicating the company’s robust financial health and stable outlook, providing assurance to Medicare Advantage Plan subscribers regarding the company’s ability to deliver promised benefits and services.
With the Humana USAA Honor partnership, both companies continue to demonstrate their commitment to serving the Medicare community.
Humana’s financial performance for the fourth quarter of 2022 showed a GAAP loss per share of $0.12, but an adjusted earnings per share of $1.62 for the same period. The GAAP earnings per share for the full year of 2022 were $22.08, and the company has confirmed its adjusted earnings per share guidance for the full year of 2023.
Member Satisfaction
The Medicare Advantage plans offered by Humana in California have the following ratings and statistics:
- Consistently receive 4-star ratings or higher, indicating a positive level of member satisfaction
- The member retention rate is 94%
- 61% of members are enrolled in plans rated 4.5 stars and above.
Despite these positive ratings, there are criticisms and areas for improvement identified in evaluations for Humana Medicare Advantage plans in California, including:
- Customer service challenges
- Coverage issues
- Limited network of healthcare providers
- High out-of-pocket costs for specific services
- Lack of transparency in plan details and modifications.
Quality of Care
The quality-of-care ratings for Humana’s plans, as evaluated by the National Committee for Quality Assurance, vary from 2.5 to 4.0 out of 5, with certain plans attaining top scores. These ratings are based on a weighted average of their:
- Healthcare Effectiveness Data and Information Set (HEDIS) measure ratings
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) measure ratings
- Health Outcomes Survey (HOS) measure ratings
- Accreditation bonus point
Tips for Choosing the Right Plan
Choosing the right Medicare Advantage plan can be a complex task. Here are some factors to consider:
- Costs, including premiums, copays, and out-of-pocket maximums
- Network availability and if your preferred providers fall within the network
- Extra benefits and how they align with your individual needs and preferences
Taking these factors into account, including race color national origin age disability sex sexual orientation gender identity, expression transgender status marital, and ca ct dc de, will help you make an informed decision.
It’s important to remember that the best plan for you depends on your unique healthcare needs, lifestyle, and budget.
Understanding Costs
Comprehending the costs tied to Humana’s Medicare Advantage Plans is an integral step toward selecting the right plan. These costs include the projected average premiums for Humana Medicare Advantage Plans in California, which are estimated to be $18.50 per month in 2025.
The role of copays in Humana’s Medicare Advantage Plans represents specific dollar amounts that members are required to pay for services, such as primary care visits.
Moreover, out-of-pocket maximums serve as a cap on spending for covered services, providing financial protection.
Network Availability
Grasping the concept of network availability is another essential aspect in the process of choosing the right plan. Your network is the group of healthcare providers who have a contract with Humana to provide healthcare services.
In-network providers have a signed contract with Humana’s health plans, while out-of-network providers do not. In-network providers generally offer services at a lower cost compared to out-of-network providers.
You can identify whether a physician is included in the Humana Medicare Advantage Plan network in California by reviewing your coverage specifics on the Humana website, where you can search for network providers.
Extra Benefits
Assessing the extra benefits is yet another important factor to consider while choosing a plan. Humana Medicare Advantage Plans encompass various wellness initiatives, including:
- The Go365 well-being and rewards program
- Sharecare for health and wellness management
- The SilverSneakers health and fitness program, provides complimentary membership to local gyms and fitness centers as part of the fitness program benefit.
Members of Humana Medicare Advantage Plans are eligible for an over-the-counter allowance which can be utilized for the purchase of qualifying non-prescription items, along with a range of health and wellness products.
The telehealth services benefit offered by Humana enables beneficiaries of the Medicare Advantage Plan to access care for minor illnesses or behavioral health issues through video-conference appointments from the comfort of their homes.
Summary
In conclusion, Humana’s Medicare Advantage Plans in California for 2025 offer a wide array of options with comprehensive coverage, encompassing a variety of health services. With an average star rating surpassing the national average, a high member retention rate, and a variety of plans to suit different needs, Humana stands out as a competitive choice among Medicare Advantage providers.
As you navigate your health coverage options, remember that the best plan for you is the one that best aligns with your individual health needs and financial situation.
Frequently Asked Questions
→ What is new in Humana in 2025?
In 2025, all Humana Medicare Advantage plans now include dental, vision, and hearing benefits, offering improved coverage for recipients looking for comprehensive healthcare options.
→ What is the Humana over-the-counter allowance for 2025?
In 2025, Humana offers a $100 quarterly allowance for purchasing approved over-the-counter health and wellness products through their OTC Mail Order provider. Unused amounts expire at the end of each quarter.
→ What are the disadvantages of Humana Medicare Advantage?
The disadvantages of Humana Medicare Advantage include a more limited choice of doctors and medical offices compared to Original Medicare, and potential overall higher costs for those with complex medical needs.
It is important to consider these factors when evaluating your healthcare options.
→ What types of Medicare Advantage Plans does Humana offer in California for 2025?
Humana offers Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Special Needs Plans (SNP) options for Medicare Advantage in California for 2025.
→ What are the costs associated with Humana’s Medicare Advantage Plans?
The costs associated with Humana’s Medicare Advantage Plans include premiums, copays, out-of-pocket maximums, and any supplementary charges for additional required benefits. These factors contribute to the overall expense of the plan.
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.