Humana Medicare Advantage Plans Massachusetts 2025
Choosing the right Humana Medicare Advantage plan in Massachusetts for 2025 is crucial for your healthcare needs.
This article strips away the confusion, offering direct insights into the new plan types, coverage enhancements, precise cost information, and streamlined enrollment steps available to Massachusetts residents seeking Humana Medicare Advantage plans in Massachusetts for 2025.
Key Takeaways
- Humana Medicare Advantage Plans in Massachusetts provide an alternative to Original Medicare with additional benefits like dental, vision, and hearing coverage, and include HMO, PPO, and PFFS plan options to cater to varying consumer needs.
- Enrollment in Humana Medicare Advantage Plans is open to all eligible individuals with designated periods such as ICEP, Open Enrollment, and Medicare Advantage Open Enrollment, ensuring access regardless of personal factors like race, gender, or disability.
- Costs for Humana Medicare Advantage Plans can differ, with an average monthly premium of $37.53 in Massachusetts for 2025; members should consider factors like deductibles, out-of-pocket maximums, and preferred pharmacy networks for additional savings.
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Understanding Humana Medicare Advantage Plans in MA
Humana Medicare Advantage plans serve as an alternative to Original Medicare, covering a wide range of medical services.
Unlike Original Medicare, a government-provided fee-for-service health insurance program, Medicare Advantage plans are administered by private insurers such as Humana and may include supplementary benefits. Humana offers Medicare Advantage HMO, PPO, and other plan types.
Humana tailors its Medicare Advantage plans to market trends, consumer needs, and preferences. Their aim is to provide plans that cater to the diverse needs of the Medicare-eligible consumers.
Information about the Annual Election Period for Medicare Advantage and Prescription Drug Plan is found in the Enrollment Periods and Eligibility Criteria section.
Types of Humana Medicare Advantage Plans Available
Humana offers Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-For-Service (PFFS) Medicare Advantage plans. These offerings cater to the diverse needs of people eligible for Medicare.
HMO plans require the use of a network of doctors and typically need referrals for specialist services. PPO plans, on the other hand, offer greater flexibility, allowing members to choose providers within and outside the network, although using out-of-network care may result in higher costs.
PFFS plans allow members to consult any Medicare-approved doctor who agrees to the plan’s payment terms and accepts the plan members.
Humana also provides free language interpreter services to ensure effective communication between members and healthcare providers.
Enrollment Periods and Eligibility Criteria
Enrolling in a Humana plan depends on contract renewal and Humana’s commitment to providing equal access to its plans and services in every area, regardless of race, color, national origin, age, disability, or sex.
The designated enrollment periods for Humana Medicare Advantage plans include:
- Initial Coverage Election Period (ICEP)
- Open Enrollment Period (October 15 – December 7)
- Medicare Advantage Open Enrollment Period (January 1 – March 31)
Comprehensive Coverage Options
Humana Medicare Advantage Plans offer comprehensive medical coverage options, including:
- Medicare benefits (Parts A and B)
- Dental coverage
- Vision coverage
- Hearing coverage
All these cover options are available in specific Humana Medicare Advantage plans and are accessible to all eligible individuals, regardless of their military or veteran status.
Medicare Advantage Prescription Drug Plans supplement medical coverage with prescription drug benefits. These plans are available in various states, including Massachusetts, and are popular among residents in the MD, ME, MI, MN region.
Prescription Drug Benefits
Humana Medicare Advantage Plans offer extensive prescription drug coverage, which can be included in Medicare Advantage plans or taken as a separate prescription drug plan. The details of the coverage may vary depending on the specific plan.
Drugs in Humana’s Medicare Advantage Plans’ formulary is covered based on a list referred to as the ‘drug list.’
This list includes commonly prescribed drugs and is meticulously curated and regularly updated by medical professionals to ensure suitability and effectiveness.
Additional Benefits and Services
Humana Medicare Advantage plans extend their coverage beyond Original Medicare Parts A and B. They include:
- Prescription drug coverage
- Routine dental, vision, and hearing benefits
- Potential additional benefits such as grocery allowances and over-the-counter products.
The dental coverage includes yearly exams, two complimentary cleanings per year, and dental X-rays once every 5 years.
Vision coverage usually includes annual eye exams, eyeglass frames with prescription lenses, and prescription contact lenses. Most Humana Medicare Advantage plans to offer their members the SilverSneakers fitness program at no extra charge.
Understanding Costs and Savings
The costs of Humana Medicare Advantage plans can vary based on income and preference for prescription drug coverage.
Generally, individuals are required to pay the Original Medicare Part B premium and Part A premium if applicable, as the foundation for medical coverage. Also, the Part B premium, which affects the total cost of the plan, may vary with income.
The average monthly premium for a Humana Medicare Advantage plan in Massachusetts is $37.53 in the year 2025. Here are some key terms to understand:
- Deductibles: These are specific amounts that you must pay out-of-pocket before the plan starts covering expenses.
- Out-of-pocket maximums: These impose a limit on the annual amount you must pay for covered services.
- It’s important to note that unless specified by the plan, Medicare Advantage plans do not have a standard out-of-pocket maximum.
Exploring Lower Cot Preferred Pharmacies
The designated pharmacies in Humana Medicare Advantage Plans consist of a network of specific pharmacy chains that may provide prescriptions at discounted prices. Some notable examples include:
- CenterWell Pharmacy
- Albertsons Companies pharmacies
- Kroger Health
- Costco
- Publix
- HEB
Preferred pharmacies typically offer lower copays and coinsurance rates, leading to significant savings on prescription drug costs for Medicare members, compared to non-preferred pharmacies which may require higher cost-sharing amounts.
All members of Humana Medicare Advantage plans are eligible to utilize preferred pharmacies, which allows them to achieve savings on prescription drug expenses by obtaining medications at a reduced cost compared to standard in-network pharmacies.
Analyzing Plan Value
Humana Medicare Advantage plans are known for their competitive pricing, with an approximate average premium of $18.50 per month in 2025.
Their Value-Based contractual agreements led to a 23.2% decrease in medical costs compared to Original Medicare in 2022, highlighting their cost-effectiveness.
The overall value of Humana Medicare Advantage plans is significantly influenced by the coverage they provide, which encompasses essential benefits such as dental, vision, and hearing services.
Additionally, the plans offer allowances for groceries and over-the-counter products that are not included in Original Medicare, effectively addressing the comprehensive healthcare requirements of members.
Network and Provider Accessibility
The provider network for Humana Medicare Advantage plans can differ based on the plan and location. It is advisable to consult Humana directly or visit their website for the latest information on their provider network.
One can locate Humana Medicare Advantage in-network providers in MA by utilizing the Humana online provider search tool. It is as simple as entering your location and searching for criteria to identify doctors within your network.
In-network vs. Out-of-Network Care
In-network care pertains to medical services offered by healthcare providers who have a contractual agreement with Humana Medicare Advantage Plans, including doctors and hospitals.
On the other hand, out-of-network care refers to medical services provided by healthcare providers that do not have a contract with these plans. Typically, in-network care is associated with lower out-of-pocket expenses and greater affordability.
Utilizing out-of-network care with Humana Medicare Advantage may lead to balance billing, where out-of-network providers may invoice you for the disparity between the agreed payment by your plan and the full amount charged for the services.
You may also encounter notably higher out-of-pocket costs if Humana denies care claims provided by out-of-network providers. It’s necessary to carefully assess your plan’s network and provider accessibility to fully grasp the potential consequences of using out-of-network providers.
Navigating Legal Protections and Rights
Members of the Humana Medicare Advantage plan is granted various rights and protections. These include:
- The right to fair and respectful treatment by Humana network providers
- Notification of their rights and duties as a member
- Protection against fraud, waste, and abuse
- The ability to request a record of disclosures of their protected health information
- Protection from surprise medical billing
Humana ensures the protection of members’ rights through various measures, such as:
- Providing a comprehensive statement of rights and responsibilities
- Allowing members to request coverage for specific items or services
- Adhering strictly to the Health Insurance Portability and Accountability Act (HIPAA) to safeguard the privacy of personal and health information.
Special Needs and Considerations
Humana Medicare Advantage provides Special Needs Plans (SNPs) that integrate the advantages of Original Medicare with additional assistance for individuals with specific requirements. They offer various types of SNPs, such as:
- D-SNPs (Dual Eligible Special Needs Plans) for individuals eligible for both Medicare and Medicaid
- C-SNPs (Chronic Condition Special Needs Plans) for individuals with qualifying chronic conditions
- I-SNPs (Institutional Special Needs Plans) for individuals residing in specific institutions.
These plans may offer supplementary benefits and personalized care to address the distinct needs of these individuals.
Indeed, Humana Medicare Advantage Plans do provide coverage for individuals with chronic conditions. They offer Chronic Condition Special Needs Plans (C-SNPs) that deliver specialized care and support for individuals with chronic conditions like diabetes, cardiovascular issues, and other eligible chronic conditions.
Humana offers routine healthcare, care management support, and integrated care to assist patients in effectively managing their chronic conditions.
How to Choose the Right Plan for You
When selecting a Humana Medicare Advantage plan, it is important to consider the following factors: Coverage, Types of Plans, Additional Benefits, and Star Ratings.
To assess your health needs for a Humana Medicare Advantage plan, you could consider having an in-home health and well-being assessment and familiarize yourself with the different types of Medicare Advantage plans that Humana offers.
To compare features of Humana Medicare Advantage plans, you should:
- Understand the types of plans and their benefits
- Use Humana’s online tools for comparing plan coverage and costs
- Consider your regular prescriptions
- Use comparison charts
- Read reviews and expert opinions to learn about plan costs, features, and benefits.
Comparing Plan Features
When assessing Humana Medicare Advantage Plans, it is important to compare features such as benefits, costs, network, prescription drug coverage, additional benefits, and plan ratings.
Humana Medicare Advantage Plans are highly rated and are among the top choices for Medicare Advantage coverage.
They provide a range of plan options with varying benefits, costs, and coverage, enabling individuals to select the most suitable plan for their requirements. Humana’s plans are on par with those offered by other leading providers such as UnitedHealthcare and Kaiser Permanente.
Assessing Personal Health Needs
Your current health status and chronic conditions have a significant impact on the Humana Medicare Advantage plan you select.
If you have ongoing health conditions or require frequent medical services, comprehensive coverage with a wide network of healthcare providers might be essential.
Humana provides Chronic Condition Special Needs Plans (C-SNPs) tailored to specific conditions, offering targeted care and management programs.
Prescription drug coverage is crucial to consider due to the necessity of regular medication for many health conditions.
Most of the Humana Medicare Advantage plans incorporate prescription drug coverage, integrating medical and medication needs into a single plan. This integration removes the need for a separate drug plan and simplifies the management of medication costs.
Transitioning from Original Medicare to Humana Medicare Advantage
Individuals looking to switch from Original Medicare to a Humana Medicare Advantage plan can enroll during the Annual Enrollment Period or a Special Enrollment Period if they meet certain eligibility criteria.
The primary disparities between Original Medicare and Humana Medicare Advantage Plans encompass:
- Administration
- Coverage
- Costs
- Network
Medicare Advantage plans such as Humana’s are administered by private insurers and may provide supplementary benefits, varying costs, and a specified network of healthcare providers.
Summary
In conclusion, Humana’s Medicare Advantage Plans offer a comprehensive and flexible alternative to Original Medicare. These plans provide a wide array of coverage options and are designed to cater to the diverse needs of Medicare-eligible individuals.
With a variety of plans available, such as HMO, PPO, and PFFS, individuals can select a plan that best suits their healthcare needs and budget.
Frequently Asked Questions
→ What is new in Humana in 2025?
In 2025, all Humana USAA Honor plans to offer a $0 monthly plan premium, a Part B giveback, and dental, vision, and hearing coverage alongside Veterans Affairs health care.
Additionally, Humana Customer Care specialists have received special training to better serve members.
→ What is the Humana over-the-counter allowance for 2025?
In 2025, Humana offers a $100 quarterly allowance for over-the-counter health and wellness products through their OTC mail order service, with any unused amount expiring at the end of the quarter.
→ What are the disadvantages of Humana Medicare Advantage?
The disadvantages of Humana Medicare Advantage include limited choice of doctors and medical offices, as well as potentially higher overall costs for complex medical needs.
It is recommended for those who don’t require expensive treatments or tests.
→ What are the types of Humana Medicare Advantage Plans available?
Humana offers Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-For-Service (PFFS) Medicare Advantage plans to choose from.
These plans provide a range of options for different healthcare needs.
→ What is the average monthly premium for Humana Medicare Advantage plans in Massachusetts for the year 2025?
The average monthly premium for a Humana Medicare Advantage plan in Massachusetts for the year 2025 is $37.53. This makes it an affordable option for coverage.
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.