Humana Medicare Advantage Plans North Carolina 2025
Welcome to the world of Humana Medicare Advantage Plans North Carolina 2025! Are you ready to take charge of your healthcare journey in the year ahead?
If yes, this guide is your valuable companion, providing you with comprehensive insights into the plan types, prescription drug coverage, and extra benefits you can expect from Humana Medicare Advantage Plans North Carolina in 2025.
Key Takeaways
- Humana’s 2025 Medicare Advantage plans for North Carolina include HMO and PPO options, extensive prescription drug coverage, additional benefits like dental and vision care, and competitive pricing with average monthly costs around $16.
- Enrollment in Humana Medicare Advantage plans is subject to eligibility prerequisites, adherence to enrolment periods, and can be completed online, by phone, or with the help of licensed insurance agents.
- Humana offers financial support options for qualifying individuals, including Dual Eligible Special Needs Plans for those with Medicare and Medicaid and assistance for low-income members through the Low-Income Subsidy program.
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Overview of Humana Medicare Advantage Plans in North Carolina for 2025
Humana’s 2025 Medicare Advantage plans in North Carolina are tailored to suit diverse healthcare needs. These plans, offered under a Medicare contract, present three different options, each with benefit values equivalent to a 90/10 plan.
The average monthly cost of these plans with prescription drug coverage is quite competitive, standing at $16, comparable to other states like MD, ME, MI, and MN. However, keep in mind that WakeMed, a major healthcare provider in the state, might be out-of-network.
Plan Types: HMO and PPO
Humana offers Medicare Advantage HMO and Preferred Provider Organization (PPO) plan options for Medicare Advantage in North Carolina.
These plans reflect Humana’s dedication to offering comprehensive coverage for eligible individuals, regardless of sex, age, disability, or national origin. They are available in North Carolina and other states, including CA, CT, DC, DE.
The HMO plan is a cost-effective choice with broader coverage for in-network services. It requires you to select a primary care physician and obtain referrals for specialists, ensuring efficient healthcare management.
On the other hand, a PPO plan gives you the flexibility to select doctors and specialists without needing a referral, catering to those who desire greater autonomy in their healthcare decisions.These plans are open to all eligible individuals.
Prescription Drug Coverage
Humana Medicare Advantage plans in North Carolina include:
- Prescription drug coverage, guaranteeing access to necessary medications
- Co-pays and deductibles for this coverage may differ depending on the specific plan chosen
- Some plans might even offer lower cost preferred pharmacies for additional savings.
These plans are also subject to contract renewal with the Centers for Medicare & Medicaid Services (CMS), ensuring they meet the necessary requirements and provide quality coverage for eligible individuals.
Humana also offers free language interpreter services, ensuring all members can access and understand their healthcare benefits and services, irrespective of their primary language.
Extra Benefits
Humana’s Medicare Advantage Plans go beyond basic healthcare coverage offered by Original Medicare, providing extra benefits such as:
- Extensive dental coverage, including routine care and specific services like extractions, periodontics, and dentures
- Vision benefits, including routine exams, discounted eye wear, and access to a wide network of providers
- Nominal copay lenses and an annual allowance for frames
- Some plans may even offer the same copay for both in-network and out-of-network providers.
Humana provides a range of wellness programs like potential prescription savings, the Humana Healthy Options Allowance, SilverSneakers fitness program, and coverage for hearing.
Comparing Humana to Other Providers in North Carolina
When choosing a Medicare Advantage plan, it’s necessary to compare it against other available options. In the case of Humana, their plans offer competitive pricing, comprehensive coverage, and high-quality performance.
The estimated average monthly premium for a Humana Medicare Advantage plan in North Carolina for 2025 is around $18.50, showcasing the competitive pricing they offer in comparison to other providers in the state.
Humana’s plans, designed to cater to the needs of Humana members, also come with comprehensive coverage options including:
- Hospitalization
- Doctor visits
- Prescription drug coverage
- Additional services such as dental and vision care
This comprehensive coverage has earned them a 5 out of 5-star rating for their HMO plan in 2025 and a significant percentage of enrollment in plans rated 4 stars and above.
Cost Comparison
While Humana’s plans typically exceed the state average in terms of cost, they provide a diverse array of options, including certain $0 premium plans, making them a viable choice for a wide range of individuals.
The average monthly premium for a Medicare Advantage plan in North Carolina is $17.10 in 2025, and Humana’s average cost for a Medicare Advantage plan with prescription drug coverage is quite competitive at $16 per month.
The premiums for Humana Medicare Advantage plans can fluctuate based on the following factors:
- The specific plan and coverage options selected
- The geographic area of plan availability
- The individual’s age and health status
- The extent of benefits and supplementary services incorporated in the plan
- The competitive and market influences in the region.
Coverage Comparison
Humana’s Medicare Advantage Plans in North Carolina offer comprehensive coverage.
The plans encompass essential health coverage as well as supplementary benefits like allowances for groceries, over-the-counter items, and certain living expenses. Their coverage is competitive, offering comprehensive benefits such as dental, vision, and hearing care.
Additionally, Humana has received favorable ratings for its Medicare Advantage plans in the region.
Their provider network in North Carolina is extensive, comprising over 350,000 medical providers and more than 3,000 hospitals, indicating a significant network when contrasted with other providers.
Quality Comparison
Quality is a cornerstone of Humana’s Medicare Advantage Plans. Their plan ratings are determined by factors like customer satisfaction, quality of care, and performance on specific healthcare measures.
Humana’s Medicare Advantage Plans in North Carolina have achieved a notable standing, with 94% of their Medicare Advantage members being enrolled in plans rated 4 stars and above.
Additionally, they were awarded the highest overall star rating for 2025 by CMS, which stands at 4.3 out of 5 stars. These ratings are influenced by member satisfaction surveys, health plan performance, and the quality of care provided by healthcare providers.
Enrollment Process for Humana Medicare Advantage Plans
The process to enroll in a Humana Medicare Advantage plan is simple. Understanding the eligibility requirements and enrollment periods can streamline this process further.
Enrollment in these plans requires individuals to be registered in both Medicare Part A and Part B. Keep in mind, there may be additional eligibility requirements based on the individual’s health condition or dual eligibility for Medicare and Medicaid.
Humana offers two key enrollment periods. The Annual Election Period (AEP) runs from October 15 to December 7, and the Medicare Advantage Open Enrollment Period (OEP) runs from January 1 to March 31 each year.
You can enroll by visiting the official Humana website, selecting a plan, and then clicking on the ‘Enroll’ button. You’ll then need to complete the enrollment form with your personal information.
Eligibility Requirements
To be eligible for Humana’s Medicare Advantage plans, individuals must meet the age requirement of being 65 years or older, be under 65 with a qualifying disability, or be living with end-stage kidney disease (ESKD).
For those residing in states like MD, ME, MI, MN, these Medicare Advantage options can provide essential healthcare coverage, ensuring that everyone has access to the care they need, regardless of national origin, age, or disability.
Enrollment in Medicare Parts A and B signifies that an individual has met the eligibility criteria for Medicare and has completed the enrollment process during the Open Enrollment period or upon reaching 65 years of age.
Additionally, to be eligible, individuals must reside within the service area covered by the plan. Humana provides these plans in 49 states, Washington, D.C., and Puerto Rico, but service areas may differ by location.
Enrollment Periods
Humana offers three key enrollment periods. The Initial Enrollment Period runs from January 1st to March 31st. Then there’s the Annual Enrollment Period, which occurs annually from October 15th to December 7th.
In addition, a Special Enrollment Period can be granted under specific circumstances such as:
- loss of current coverage
- relocation outside the coverage area
- changes in Medicaid eligibility
- other qualifying events
If you miss the enrollment period, you may be required to wait until the next enrollment period to enroll, and you may face late enrollment penalties, such as increased premiums or gaps in coverage.
How to Enroll
You have several options to enroll in Humana’s Medicare Advantage plans. You can:
- Visit the official Humana website
- Choose the plan that best fits your requirements
- Click on the ‘Enroll’ option
- Provide your date of birth, contact information, and any other necessary details in the enrollment form
- After filling out the form, review the information
- Submit the form to finalize the enrollment process.
Alternatively, you can enroll over the phone by contacting Humana at 1-888-204-4062 (TTY: 711), with customer service available daily from 8 a.m. to 8 p.m.
You can also enlist the help of a licensed insurance agent to guide you in selecting a plan and completing the necessary paperwork for the enrollment process.
Navigating Network Limitations and Out-of-Network Care
It’s vital for Humana Medicare Advantage plan members to grasp how to manage network limitations and out-of-network care. Humana provides Continuity of Care, a service that guarantees seamless access to care for individuals undergoing ongoing treatment at WakeMed.
To qualify for Continuity of Care, members who are currently receiving ongoing treatment at WakeMed can proactively reach out to Humana to start the process.
Even if WakeMed is out-of-network, any individual in need of immediate medical attention is welcome to seek treatment at any of WakeMed’s seven emergency departments.
If members have any inquiries or issues regarding Continuity of Care, they should reach out to Humana for assistance.
Network Providers
Humana’s network encompasses a vast array of healthcare providers, including:
- Primary care physicians
- Specialists
- Hospitals
- Urgent care centers
- Imaging centers
- Labs
- Home health services
However, it is important to note that WakeMed, a major healthcare provider in North Carolina, is currently outside Humana’s network.
To determine whether a provider is in-network or out-of-network for Humana Medicare Advantage, you can use the Find a doctor tool on the Humana website or contact Humana using the number provided on the back of your insurance card.
Out-of-Network Care
While out-of-network care is generally more expensive, Humana provides coverage for out-of-network emergency healthcare situations.
Humana Medicare Advantage Plans may also permit out-of-network care in specific situations such as medical emergencies or when no in-network providers are available for the needed care.
However, seeking care from an out-of-network provider may result in balance billing, where the provider bills for the difference between what the plan pays and the amount charged.
It could also lead to higher out-of-pocket costs and additional costs if claims are denied for out-of-network care.
Financial Assistance and Special Needs Plans
Humana offers financial assistance and Special Needs Plans to those who qualify for both Medicare and Medicaid or receive a Low-Income Subsidy.
Individuals must be enrolled in both Medicare and Medicaid to qualify for Humana’s Dual Eligible Special Needs Plans.
These plans provide:
- $0 copays for numerous covered prescriptions
- Dental, vision, and hearing coverage
- A Healthy Options Allowance that can be used for various expenses such as food, pet supplies, utility bills, or rent.
Individuals can complete the enrollment process for the Dual Eligible Special Needs Plan by accessing the Humana website and choosing the D-SNP plan option.
Dual Eligible Special Needs Plans
Humana does offer Dual Eligible Special Needs Plans in North Carolina. To qualify for these plans, individuals must have both Medicare and Medicaid coverage.
These plans offer a wide array of benefits, including dental, vision, and hearing benefits. Additionally, they offer potential cost benefits, including $0 copay on prescriptions and a Healthy Options Allowance with rollover.
The average premium for a Special Needs Plan in New Hanover County is $38.31 per month.
Low-Income Subsidy
The Low-Income Subsidy (LIS), also known as Extra Help, is a federal program designed to assist individuals with Medicare in covering the expenses associated with prescription drugs, including those under Medicare Part D.
It aims to decrease the financial burden by offering aid for premiums, deductibles, and copayments related to Medicare prescription drug plans.
The LIS offers a decreased amount for both generic and brand-name drugs, removes catastrophic cost-sharing, and limits annual out-of-pocket drug expenses.
This support can effectively alleviate the financial strain of prescription medications for qualified beneficiaries.
Individuals must meet specific criteria to be eligible for a LIS for Humana Medicare Advantage Plans in North Carolina and can apply via the Social Security Administration.
Summary
Humana’s Medicare Advantage Plans in North Carolina for 2025 offer a comprehensive package of healthcare services, flexibility, and cost savings. Whether you’re seeking routine medical care, prescription drug coverage, or additional benefits like dental and vision care, these plans are designed to meet your unique needs.
By understanding the details of these plans, their costs and coverage, and how they compare to other providers, you can make an informed decision to ensure your healthcare journey in the year ahead is smooth and affordable.
Frequently Asked Questions
→ What is new in Humana in 2025?
In 2025, Humana’s USAA Honor plan offers a $0 monthly plan premium, Part B giveback, dental, vision, and hearing coverage, coverage that works alongside VA health care, and access to specially trained Humana Customer Care specialists’ services.
Additionally, Humana Medicare Advantage plans now offer dental, vision, and hearing benefits.
→ What are Medicare changes for 2025?
In 2025, Medicare Part B premiums will increase to $174.70 per month, up from $164.90 in 2023. The Part B deductible will also rise to $240, an increase from $226 in 2023.
→ What is the Humana over the counter allowance for 2025?
In 2025, Humana offers a $100 quarterly allowance for approved over-the-counter health and wellness products through their OTC Mail Order provider. Unused funds expire at the end of each quarter.
→ What beneits do the Humana Medicare Advantage Plans in North Carolina for 2025 offer?
The Humana Medicare Advantage Plans in North Carolina for 2025 offer comprehensive healthcare coverage, prescription drug coverage, dental, vision, and wellness programs as extra benefits.
→ How does Humana compare to other Medicare Advantage providers in North Carolina?
Humana stands out in North Carolina for its competitive pricing, comprehensive coverage, and high-quality performance, with a significant number of plans rated 4 stars and above. This makes them a strong choice for Medicare Advantage.
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.