Humana Medicare Advantage Plans Missouri 2025
Choosing the right Humana Medicare Advantage plan in Missouri for 2025 just got easier. In this straightforward guide, we dive into the specifics of Humana’s latest plan options, new benefits and updates exclusive to Missouri residents.
You’ll find exactly what you need to compare, contrast, and comprehend the changes for Humana Medicare Advantage Plans Missouri for 2025, enabling you to make an informed decision with confidence.
Expect clear and actionable information ahead – no sales talk, just the essentials mapped out for you.
Key Takeaways
- Humana and UnitedHealthcare continue to dominate the Missouri Medicare Advantage market for 2025, with Humana expanding into 140 new counties in 2025, reflecting a strategic growth to cater to both urban and rural areas despite accessibility challenges.
- Humana’s Medicare Advantage plans in Missouri include HMO, PPO, and PFFS options, emphasizing flexibility, comprehensive benefits including prescription drug coverage, and network access with additional benefits like telehealth, wellness programs, and dental/vision/hearing coverage.
- Cost considerations for Missouri beneficiaries entail analyzing varying premiums, cost-sharing details such as copayments and deductibles, and out-of-pocket maximums, with an enrollment process that hinges on eligibility criteria such as age, disability, and residency, and includes special provisions for dual eligible.
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Missouri’s Medicare Advantage Landscape in 2025
The year 2025 has ushered in significant changes in Missouri’s Medicare Advantage market. New entrants like Champion Health Plan, Peak Health, and Verda Health Plan of Texas are challenging the status quo, offering Medicare Advantage plans that cater to a diverse range of needs.
On the other hand, co-branded partnerships such as UnitedHealthcare with Walgreens, Select Health with Kroger, and Alignment Health with Rite Aid are shaping the landscape by offering customized plan options.
Amidst these changes, two key players continue to dominate—Humana and UnitedHealthcare.
Top Providers: Humana, UnitedHealthcare, and others
Humana and UnitedHealthcare are the leading forces in the Medicare Advantage market in Missouri, representing roughly half of the enrollment in 2023. Their dominance is attributed to:
- Extensive coverage
- Comprehensive benefits
- Competitive pricing
- Outstanding star ratings evaluated by the Centers for Medicare & Medicaid Services.
Beneficiaries have a wide array of plan options, recognized for their comprehensive benefits and cost-effectiveness.
Market Expansion: New counties and plan availability
Humana’s expansive reach is evident in its 2025 expansion into 140 new counties. Providing plans in 90% of counties, Humana now offers plans in 2,906 counties, covering states like:
- Missouri
- Maryland
- Maine
- Michigan
- Minnesota
This expansion is driven by Humana’s strategic growth, the urbanicity of a county, and opportunities to re-enter the individual market.
Rural vs. Urban Areas: Differences in plan offerings and accessibility
The landscape of Medicare Advantage is not uniform across Missouri. While urban areas saw a 7% increase in enrollment, rural areas experienced a 13% growth in 2022.
Medicare beneficiaries in rural areas, however, face unique challenges including coverage denials from Medicare Advantage plans for rural hospitals, limited access to necessary services during disasters, and challenges in obtaining healthcare services due to provider network barriers.
Despite these obstacles, providers are taking measures to bridge the accessibility gap, supporting rural providers, expanding access to care in rural areas, and transforming the rural health delivery system.
Humana’s Medicare Advantage Offerings in Missouri
Humana, in its commitment to cater to diverse healthcare needs, offers a variety of Medicare Advantage plans in Missouri. These include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-for-Service (PFFS) options.
Each plan type has its unique features, benefits, and network restrictions.
Humana also offers free language interpreter services to facilitate clear communication with beneficiaries who do not speak English.
Plan Types: HMO, PPO, and PFFS
Humana offers three types of plans to cater to different healthcare preferences:
- PPO plans offer more flexibility, allowing beneficiaries to choose any doctor or hospital that accepts Medicare without being restricted to a network.
- PFFS plans offer access to any Medicare-approved healthcare provider who agrees to the terms and conditions of the plan.
Each plan type presents a variety of choices, all with their unique benefits and compromises.
Prescription Drug Coverage: Inclusion and cost-sharing details
Prescription drug coverage is an integral part of Humana’s Medicare Advantage plans. Offering three distinct Medicare Part D prescription drug plans, Humana categorizes prescription drugs into tiers based on their cost and coverage.
Beneficiaries can verify whether specialty drugs are included in their coverage and obtain detailed cost-sharing information by logging into MyHumana, using Humana’s search tool, or contacting Humana directly.
Network Restrictions: Provider networks and referrals
Humana’s network of Medicare-approved providers is extensive, offering both Medicare Advantage HMO and PPO options. Beneficiaries can seek medical care from any doctor within or outside of the network.
While the HumanaChoice PPO Medicare Advantage plan offers flexibility in physician selection, there are no limitations for accessing specialists across all plans.
Humana’s Member Services specialists are also available to help identify mental health therapists and providers within the individual’s plan.
Extra Benefits and Services
Humana goes beyond the norm by offering extra benefits and services to its Medicare Advantage plan members.
These include:
- Telehealth services for remote healthcare access
- Wellness programs like SilverSneakers for physical wellbeing
- Dental, vision, and hearing coverage for comprehensive healthcare benefits.
Telehealth Services: Availability and scope
Telehealth services are fast becoming a vital part of healthcare, and Humana ensures its beneficiaries don’t miss out.
Offering virtual visits for both medical and behavioral health, Humana uses remote access technologies and telemonitoring services to bring healthcare to beneficiaries at their convenience.
Nonetheless, some restrictions may apply, and beneficiaries should consult the official Humana website or their customer service for complete information.
Wellness Programs: SilverSneakers and other fitness benefits
Keeping fit is a crucial part of healthy aging, and Humana recognizes this by incorporating wellness programs into its Medicare Advantage plans. With fitness benefits like SilverSneakers, beneficiaries have access to a health and fitness program specifically tailored for individuals with Medicare.
This program is typically included in most Humana Medicare Advantage plans at no extra cost.
Dental, Vision, and Hearing Coverage: Scope and limitations
Humana believes in comprehensive health coverage. That’s why, in addition to regular health benefits, Humana Medicare Advantage plans in Missouri provide dental, vision, and hearing benefits.
However, these benefits can vary in scope and limitations.
The dental benefit coverage can include:
- Cleanings and preventive care
- X-rays
- Fillings
- Root canals
- Extractions
- Crowns
- Dentures
- Orthodontic treatment
The coverage often comes with an annual dollar cap. For optimal benefit, reviewing the specifics of each plan is recommended.
Cost Considerations for Missouri Beneficiaries
Choosing a Medicare Advantage plan involves more than just comparing benefits. Costs play a significant role in determining the right plan.
From premiums, including the Medicare Part B premium, to cost-sharing mechanisms like copayments and deductibles, and out-of-pocket maximums, understanding how these factors affect your overall healthcare budget can help you make an informed choice.
Premiums: Comparing costs for different plan types
When it comes to premiums, one size doesn’t fit all. The costs of premiums for HMO, PPO, and PFFS plans vary. The specific costs are contingent on the plan and the provider.
Beneficiaries should consider comparing the benefits, costs, and coverage of different plans comprehensively to identify the most suitable option for their needs.
Cost-Sharing: Copayments, coinsurance, and deductibles
Cost-sharing is a fundamental part of Humana’s Medicare Advantage plans. By splitting the costs of healthcare services between the insurer and beneficiaries, cost-sharing mechanisms like copayments, coinsurance, and deductibles make healthcare more affordable.
However, the specifics of these cost-sharing mechanisms may differ based on the selected plan.
Out-of-Pocket Maximums: Limitations on annual expenses
Out-of-pocket maximums act as a safety net, limiting the amount you must spend on healthcare services in a year.
Once you reach your out-of-pocket maximum, you won’t have to pay anything for covered services for the rest of the planned year. However, these maximums can vary among different plan types like HMO, PPO, and PFFS.
Enrollment Process and Eligibility Criteria
Understanding the enrollment process and eligibility criteria is an important step in joining a Humana Medicare Advantage plan. With initial, annual, and special enrollment periods, there are various opportunities to join or switch plans.
Eligibility is typically based on being enrolled in both Medicare Part A and Part B, and additional qualifications may involve receiving Social Security Disability Insurance (SSDI) benefits for 24 months or having a disability determination from the Railroad Retirement Board.
Enrollment Periods: Initial, Annual, and Special Enrollment Periods
The Initial Enrollment Period, which spans from January 1 to March 31, is the first opportunity to join a Medicare Advantage plan. If you miss this period, you can join or switch plans during the Annual Enrollment Period from October 15 to December 7.
Finally, the Special Enrollment Period and the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, allow beneficiaries to make changes like switching to a different Medicare Advantage plan or moving from Original Medicare to a Medicare Advantage plan.
Eligibility Requirements: Age, disability, and residency
To qualify for a Humana Medicare Advantage plan, individuals must meet the following criteria, regardless of their national origin age disability status:
- Be 65 years of age or older
- Have a disability that meets the criteria for eligibility
- Be under the age of 65 and have received disability benefits from Social Security or the Railroad Retirement Board for a minimum of 24 months
Additionally, residency in the state of Missouri (MD, ME, MI, MN) is a requirement.
Dual Eligible Special Needs Plans: Options for those eligible for both Medicare and Medicaid
If you qualify for both Medicare and Medicaid, you may be eligible for Humana’s Dual Eligible Special Needs Plans (D-SNPs). These plans are tailored to offer extensive coverage, potentially including supplementary benefits like dental, vision, and hearing services.
To enroll, one must meet the eligibility criteria for both Medicare and Medicaid, and the enrollment process can be initiated by directly contacting Humana or visiting their website.
Navigating Humana’s Provider Network
Once you’ve enrolled in a plan, the next step is to navigate Humana’s provider network. Here are some important steps to follow:
- Use online tools to find in-network providers.
- Identify preferred pharmacies for lower-cost options.
- Understand out-of-state coverage provisions for travel and emergency care.
Each step is crucial in ensuring you get the most out of your plan.
Finding In-Network Providers: Online tools and directories
Humana’s ‘Find a doctor’ or ‘Provider search’ tool on its website is a great resource for finding in-network healthcare providers.
By entering your location or zip code and adjusting the search radius, you can access a list of in-network providers that match your criteria.
This tool can be accessed on the Humana website or by contacting their customer service.
Preferred Pharmacies: Lower-cost options and accessibility
Prescription costs can be a significant part of healthcare expenses. Humana’s preferred pharmacy program can help you save.
By offering medications at a reduced cost at participating lower cost preferred pharmacies like CenterWell Pharmacy™, preferred pharmacies can significantly reduce your out-of-pocket expenses on prescriptions.
Out-of-State Coverage: Travel and emergency care provisions
Life doesn’t stop when you travel, and neither should your healthcare. Humana’s Medicare Advantage plan offers coverage for emergency care services while traveling, including ground ambulance transportation to hospitals, critical access hospitals, or skilled nursing facilities.
Moreover, the plan provides coverage for emergencies that may arise while traveling outside of the United States.
Nonetheless, certain limitations or restrictions may apply, and beneficiaries should review their plan details or directly contact Humana for precise information about out-of-state coverage limits or restrictions.
Summary
Navigating the Medicare Advantage landscape can be a complex process, but with the right knowledge, it becomes a lot simpler.
Whether you’re drawn to Humana’s extensive coverage, the flexibility of its HMO, PPO, and PFFS plans, the extra benefits like telehealth services and wellness programs, or the comprehensive cost considerations, Humana offers a variety of plans tailored to meet diverse healthcare needs.
Remember, the best plan is the one that best fits your health needs and budget. So, equip yourself with the right knowledge, weigh your options, and make an informed decision.
Frequently Asked Questions
→ What is new in Humana in 2025?
In 2025, Humana’s Medicare Advantage (MA) plans now include dental, vision, and hearing benefits, providing enhanced coverage for beneficiaries.
→ What is the Humana over-the-counter allowance for 2025?
The Humana over-the-counter allowance for 2025 is a $100 quarterly allowance for purchasing approved health and wellness products through their OTC mail-order provider, 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 compared to Original Medicare, potentially higher overall costs for complex medical needs, and the requirement to use the plan’s network of doctors and health providers.
→ What types of Medicare Advantage plans does Humana provide in Missouri?
Humana provides a variety of Medicare Advantage plans in Missouri, including HMO, PPO, and PFFS options. You have multiple options to choose from based on your needs.
→ How can I find in-network providers with Humana in Missouri?
To find in-network providers with Humana in Missouri, you can use the ‘Find a doctor’ or ‘Provider search’ tool on Humana’s website, which allows you to search for providers based on your location or zip code.
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.