Humana Medicare Advantage Plans North Carolina 2025
Are you planning on navigating some of the potential Humana Medicare Advantage Plans in North Carolina for 2025?
If yes, this guide could be a valuable resource, providing you with comprehensive insights into the possible plan types, prescription drug coverage, and other potential benefits you might expect from Humana Medicare Advantage Plans in North Carolina for 2025.
Key Takeaways
- Humana’s Medicare Advantage plans for North Carolina include HMO and PPO options, and could potentially include prescription drug coverage and other possible benefits like dental and vision care.
- Enrollment in Humana Medicare Advantage plans is subject to eligibility prerequisites, adherence to enrolment periods, and can be completed by calling one of our licensed agents at 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST.
- Humana could potentially offer financial support options for qualifying individuals, which might include certain Dual Eligible Special Needs Plans for those with Medicare and Medicaid and might provide assistance for low-income members through the Low-Income Subsidy program.
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Overview of the Potential Humana Medicare Advantage Plans in North Carolina
Some of Humana’s Medicare Advantage plans in North Carolina will likely be tailored to suit diverse healthcare needs. Some of these plans, which may be offered under a Medicare contract, present two options: HMO and PPO.
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 California, Connecticut, DC, Delaware, and others.
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
Some Humana Medicare Advantage plans in North Carolina could potentially include:
- Prescription drug coverage, which may guarantee access to necessary medications
- The potential 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.
Some of these plans might be subject to contract renewal with the Centers for Medicare & Medicaid Services (CMS), possibly ensuring the plans may meet the requirements and provide quality coverage for eligible individuals.
Humana may also offer free language interpreter services, ensuring all members may access and understand their potential healthcare benefits and services, irrespective of their primary language.
Potential Extra Benefits
Certain Humana’s Medicare Advantage Plans may go beyond basic healthcare coverage offered by Original Medicare, by potentially providing extra benefits such as:
- Extensive dental coverage, which may include routine care and specific services like extractions, periodontics, and dentures
- Vision benefits, possibly 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.
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, some of their plans may offer competitive pricing, comprehensive coverage, and high-quality performance.
Some of Humana’s plans, designed to cater to the needs of Humana members, might come with comprehensive coverage options, which could potentially include:
- Hospitalization
- Doctor visits
- Prescription drug coverage
- Additional services such as dental and vision care
This comprehensive coverage might have earned Humana a 5 out of 5-star rating for their HMO plan and a significant percentage of enrollment in plans rated 4 stars and above.
Potential Cost Comparison
The possible premiums for certain Humana Medicare Advantage plans may fluctuate based on some of these potential factors:
- The specific plan and coverage options selected
- The geographic area of plan availability
- The individual’s age and health status
- The extent of possible benefits and supplementary services that may be incorporated into certain plans
- The competitive and market influences in the region.
Coverage Comparison
Some of Humana’s Medicare Advantage Plans in North Carolina may also offer comprehensive coverage. These plans might encompass essential health coverage as well as comprehensive benefits such as dental, vision, and hearing care.
Humana’s provider network in North Carolina may be extensive, potentially comprising over 350,000 medical providers and more than 3,000 hospitals, possibly indicating a significant network when contrasted with other providers.
Quality Comparison
Quality is a cornerstone of Humana’s Medicare Advantage Plans. Some of their plan ratings may be determined by factors like customer satisfaction, quality of care, and performance on specific healthcare measures.
A majority of Humana’s Medicare Advantage Plans in North Carolina may have achieved a notable standing, with at least 94% of their Medicare Advantage members being enrolled in plans rated 4 stars and above.
Additionally, Huama has been awarded the highest overall star rating in previous years by CMS, which stands at 4.3 out of 5 stars. These ratings will likely be 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, that 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.
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 North Dakota, some of these Medicare Advantage options could potentially provide essential healthcare coverage, ensuring that everyone has access to the care they need.
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 may only provide 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 may 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
By calling 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST, one of our licensed agents can provide comprehensive information, personalized guidance, and ongoing assistance to navigate the enrollment process for private insurance companies, making it easier for beneficiaries to make informed decisions about their healthcare.
Navigating Network Limitations and Out-of-Network Care
It’s vital for Humana Medicare Advantage plan members to grasp how to manage their potential network limitations and out-of-network care.
Network Providers
Humana’s network might encompass a vast array of healthcare providers, including:
- Primary care physicians
- Specialists
- Hospitals
- Urgent care centers
- Imaging centers
- Labs
- Home health services
To determine whether a provider is in-network or out-of-network for Humana Medicare Advantage, you may 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 may be more expensive, Humana will likely 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 may also lead to higher out-of-pocket costs and additional costs if claims are denied for out-of-network care.
Potential Financial Assistance and Special Needs Plans
Humana might offer 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.
Individuals may complete the enrollment process for the Dual Eligible Special Needs Plan by calling 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST.
Dual Eligible Special Needs Plans
Humana might also offer Dual Eligible Special Needs Plans in North Carolina. To qualify for these plans, individuals must have both Medicare and Medicaid coverage.
Some of these plans might offer a wide array of potential benefits, including dental, vision, and hearing benefits.
Low-Income Subsidy
The Low-Income Subsidy (LIS), also known as Extra Help, is a federal program that will likely be designed to assist individuals with Medicare in covering certain expenses that may be associated with prescription drugs, including those under Medicare Part D.
It may aim to decrease the financial burden by potentially offering aid for premiums, deductibles, and copayments related to certain Medicare prescription drug plans.
The LIS might also offer a decreased amount for both generic and brand-name drugs, potentially removing catastrophic cost-sharing, and may even set limits on annual out-of-pocket drug expenses.
This support could effectively alleviate some of the financial strain of certain prescription medications for qualified beneficiaries.
Individuals must meet specific criteria to be eligible for an LIS for Humana Medicare Advantage Plans in North Carolina and can apply via the Social Security Administration.
Summary
A majority of Humana’s Medicare Advantage Plans in North Carolina for 2025 will likely offer a comprehensive package of potential healthcare services, flexibility, and cost savings. Whether you’re seeking possible routine medical care, prescription drug coverage, or other benefits like dental and vision care, these plans could be designed to meet your unique needs.
By understanding the potential details of these plans, their possible costs and coverage, and how they could compare to other providers, you may 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, some of the Humana Medicare Advantage plans may offer dental, vision, and hearing benefits. For additional information about the plans for the 2025 calendar year, be sure to keep checking back to this website for updates.
→ What potential benefits could the Humana Medicare Advantage Plans in North Carolina offer?
Some of the Humana Medicare Advantage Plans in North Carolina could potentially offer comprehensive healthcare coverage, prescription drug coverage, and dental, vision, and hearing services as extra benefits.
→ How does Humana compare to other Medicare Advantage providers in North Carolina?
Humana will likely stand out in North Carolina for potentially providing competitive pricing, comprehensive coverage, and high-quality performance, with a significant number of plans rated 4 stars and above. This could make 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.