Humana Medicare Advantage Plans Wisconsin 2025
Discover the essentials of Humana Medicare Advantage Plans in Wisconsin for 2025 with this expert guide. Uncover the newly released plan features designed to enhance your healthcare experience.
With focused details on how these plans can offer you cost savings and better coverage in the coming year; this guide steers clear of fluff to provide you with the actionable insights you need.
Dive into our resources to find a plan tailored to your Wisconsin healthcare needs in 2025.
Key Takeaways
- Humana offers a variety of Medicare Advantage plans in Wisconsin for 2025, including HMO, PPO, and PFFS options, with the majority incorporating prescription drug coverage and some providing Part B premium reductions.
- Cost savings are a key component of Humana’s Medicare Advantage plans, with opportunities that include reduced cost sharing, preferred pharmacy networks providing lower-cost prescriptions, and special plans like the Humana Premier Rx Plan™ covering a broad range of medications.
- Qualifying for Humana’s plans requires being over 65 or meeting disability criteria, and plan selection should consider an individual’s specific healthcare needs, including provider network, prescription coverage, and additional benefits, with annual contract renewals and licensed sales agents available for support.
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Understanding Humana’s Medicare Advantage Offerings in Wisconsin for 2025
Humana, a renowned insurance provider, is offering Medicare Advantage plans in Wisconsin for the upcoming year, including Medicare Advantage HMO options. These plans, which also include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-for-Service (PFFS) options, are designed to cater to the diverse needs and preferences of Medicare-eligible individuals.
Indeed, an impressive 89% of these plans are set to incorporate prescription drug coverage in 2025, with 99% of beneficiaries having access to a Medicare Advantage Prescription Drug plan with no additional monthly premium.
However, it’s not all about quantity. Quality matters too. A slight 1% decline in the number of Medicare Advantage plans has been observed for 2025 when compared to the previous year. But don’t let this discourage you.
On a brighter note, 19% of these plans are expected to offer some reduction in the Part B premium for enrollees. What’s more, a $0-premium Medicare Advantage plan will be accessible to all Medicare-eligible individuals in Wisconsin, ensuring healthcare is within reach for all.
Types of Humana Advantage Plans
Humana offers four types of Medicare Advantage plans – HMO, PPO, SNP, and PFFS – each designed with unique features to cater to various health needs. The HMO plans are for those who prefer to have a designated primary care physician (PCP) and don’t mind getting referrals for specialists.
These plans may include routine dental, vision, and hearing benefits, ensuring all-round healthcare coverage.
This plan provides comprehensive coverage, including Medicare Parts A and B benefits, and even incorporates an annual plan review for added assurance.
For those who want the utmost liberty in provider selection, the PFFS plan may be a good fit. This plan provides:
- Extensive Medicare Part A and B benefits
- Prescription drug and emergency coverage, both within and outside the U.S.
- An annual maximum out-of-pocket cost limit for added financial security.
Plan Benefits and Features
Not only the type of plan, but also the benefits and features it offers should be taken into consideration when selecting a plan. Humana’s Medicare Advantage Plans in Wisconsin provide a broad range of benefits.
For example, they include prescription drug coverage, which is a critical aspect considering the rising costs of medications. Humana’s plans include a Part D plan known as Humana Premier Rx Plan™, covering a wide range of over 3,700 prescription drugs.
Moreover, these plans also offer dental benefits, though with limitations such as an annual dollar cap. But don’t worry – vision and hearing coverage are part of the package too, offering comprehensive coverage for your healthcare needs.
What’s unique about Medicare Advantage plans, including Humana’s, is that certain extra benefits can be restricted to specific subgroups of beneficiaries. For instance, individuals with conditions like diabetes or congestive heart failure can receive benefits tailored to their needs.
Enrollment and Eligibility Criteria
Before being enticed by the range of benefits that Humana’s plans offer, you must ensure that you meet the enrollment eligibility criteria. To be eligible for Humana’s Medicare Advantage Plans, you must be 65 years or older.
However, provisions are in place for those under 65 who have a disability or end-stage renal disease, allowing them to qualify for enrollment.
In addition to national origin, age, or health status, there are other requirements. To enroll in Humana’s Medicare Advantage plans in Wisconsin, for instance, you must be a U.S. citizen or legal resident for five or more years.
You must also be enrolled in Medicare Part A and Part B, whether you’re aged 65 and above or under 65 and meet the criteria for disability or end-stage renal disease.
Analyzing Costs and Savings with Humana Plans
Even though comprehensive coverage and a variety of plans are advantageous, it’s undeniable that cost plays a significant role in health plan selection. The good news is that Humana’s Medicare Advantage plans offer several cost-saving opportunities.
These include reduced cost sharing, additional supplemental benefits, and a Part B premium reduction benefit on certain plans.
The level of savings from Humana’s Part B premium reduction can vary based on the specific Medicare Advantage plan.
Additionally, Humana’s plans prioritize certain pharmacy networks, including:
- CenterWell Pharmacy
- Albertsons Companies pharmacies
- Kroger Health
- Costco
- Publix
- HEB
- Walgreens
These lower cost preferred pharmacies offer prescriptions at a reduced cost compared to other providers like standard in-network pharmacies, providing financial incentives for beneficiaries.
Understanding the Part B Premium Reduction
The Part B premium reduction, also known as the Medicare Giveback Benefit or the Part B Giveback, is a program designed to pay part or all the Medicare Part B premium.
It’s a wonderful benefit offered by some Medicare Part C (Medicare Advantage) plans, including some of Humana’s, to assist in reducing beneficiaries’ Part B premium costs.
The potential savings from Humana’s Part B premium reduction can be quite significant. Depending on the specific Medicare Advantage plan, beneficiaries could save anywhere from $40 to $75 per month.
That’s a potential annual saving of up to $900 – a substantial amount that could be utilized elsewhere. In Wisconsin for 2025, plans offering the Part B premium reduction include features like the Medicare Giveback Benefit and options like the Humana USAA Honor plan.
Preferred Pharmacy Networks
Pharmacy costs can quickly add up, especially if you have multiple prescriptions. That’s where Humana’s preferred pharmacy networks come in.
These networks provide discounted prices to Humana members, making medications more affordable.
While you have the option to use non-preferred pharmacies, doing so may incur extra expenses. It’s also important to present your Humana member ID card when using a pharmacy within the network.
By offering medications at a reduced cost compared to standard in-network cost-share pharmacies, Humana’s preferred pharmacy networks enable you to pay lower copayments for Tier 1 and 2 prescriptions, leading to significant cost savings.
Performance and Ratings: Humana’s CMS Star Ratings
Just like how we rely on Yelp reviews to choose a restaurant, CMS Star Ratings help us evaluate the quality and effectiveness of Medicare Advantage plans.
These ratings, ranging from 1 to 5 stars, are determined based on factors like member satisfaction, health outcomes, and customer service.
The quality of Humana’s plans is mirrored in their performance in these ratings. However, it’s important to note that the specific data on the comparison of Humana’s CMS Star Ratings in Wisconsin with other Medicare Advantage providers is not provided, suggesting that explicit comparisons may not be readily available.
Special Needs Plans and Dual Eligibility
Humana acknowledges that healthcare cannot be generalized to fit everyone equally. That’s why they offer a Humana plan called Special Needs Plans (SNPs) for Medicare beneficiaries with specific health conditions or dual eligibility for both Medicare and Medicaid services.
Eligibility for these plans differs based on the plan type. For instance, Dual-Eligible Special Needs Plans (D-SNPs) are designed for individuals who are eligible for both Medicare and Medicaid.
Chronic Condition Special Needs Plans (C-SNPs) are tailored for individuals with conditions such as diabetes, chronic heart failure, and other chronic or disabling conditions.
Dual eligible beneficiaries in these plans receive a wide range of benefits, including coverage for dental, vision, and hearing services.
Insights into Humana’s Healthcare Network in Wisconsin
Humana’s healthcare network in Wisconsin spans a wide range of providers, hospitals, and specialists, ensuring that plan members have access to comprehensive and high-quality care.
Notable providers in the network include Aurora Health Care, the largest provider in the state, along with three other significant healthcare systems in southeastern Wisconsin, such as Centerwell Health Care Services.
Humana Insurance Company also provides extensive coverage for specialty care, encompassing specialized healthcare through Medicare Special Needs Plans (SNPs) and specialty Rx services for medication management and other tailored healthcare needs.
So, no matter what your healthcare needs are, Humana’s healthcare network in Wisconsin, including their Humana insurance services, has got you covered.
Tailoring Your Plan Choice: Factors to Consider
The decision about a plan isn’t merely based on understanding what each plan offers. It’s also about identifying a plan that caters to your needs. Factors such as:
- costs
- provider network
- prescription drug coverage
- additional benefits
Factors such as location, personal needs, and disability should all be considered when choosing a Humana Medicare Advantage plan for Medicare Advantage members.
The cost of Humana’s Medicare Advantage plans plays a significant role in determining the affordability and value proposition for individuals, as the right Humana plan depends on several factors.
The provider network is equally important as it directly impacts the accessibility of preferred doctors, hospitals, and specialists, as well as potential out-of-pocket costs.
Prescription drug coverage also plays a significant role in the selection of a Humana Medicare Advantage plan as it directly impacts whether beneficiaries will have access to both medical coverage and medication within a single plan.
The Importance of Medicare Contract Renewal
After settling on a plan, it’s crucial to be aware that plans could change or be discontinued due to annual contract agreements. This is why Medicare contract renewal is essential.
The annual contract renewal process for Humana’s Medicare Advantage Plans entails the automatic renewal of the plan on an annual basis. It is crucial to carefully review any modifications to ensure that the plan continues to align with your requirements.
If a plan is not renewed, there is a risk of losing coverage and being defaulted back to Original Medicare. Hence, it’s of utmost importance to choose a new plan to guarantee the continuity of the coverage you require.
Navigating Plan Selection with Licensed Sales Agents
The process of selecting a Medicare Advantage plan can seem daunting. However, rest assured, you’re not expected to navigate it alone. Licensed sales agents, also known as brokers, can guide you through the process.
These individuals are licensed and well-informed about Medicare plans and can assist beneficiaries in navigating the intricate process of choosing the appropriate coverage.
Licensed sales agents can help you with the following:
- Evaluate individual healthcare needs and suggest plans that align with those needs
- Help you understand the various Medicare Advantage plans and their advantages
- Lead you through the available options
- Aid in plan selection and enrollment navigation.
Summary
In conclusion, finding the best Medicare Advantage Plan available in your area is an essential step in securing the coverage you need while saving money.
By understanding the different types of plans, comparing costs and coverage, evaluating provider networks, and enrolling in the right plan during your Initial or Special Enrollment Period, you can ensure that you have comprehensive coverage tailored to your needs.
Don’t hesitate to explore additional Medicare coverage options, such as Medicare Supplement Plans and Standalone Prescription Drug Plans, to guarantee you have the best possible coverage for your healthcare needs.
Frequently Asked Questions
→ What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage plans may have limited provider networks, co-payment requirements, and annual caps on out-of-pocket spending, making them less flexible than Original Medicare.
→ Why are people leaving Medicare Advantage plans?
People are leaving Medicare Advantage plans due to excessive prior authorization denial rates, slow payments from insurers, and allegations of billing fraud from the federal government.
→ What is the best Medicare Advantage plan for 2025?
For the best Medicare Advantage plan in 2025, Humana is highly recommended based on its top ratings, positive customer feedback, wide selection of plans, and multiple $0-per-month options. Customers report high-quality care with Humana plans compared to AARP/UHC.
→ What additional benefits can I expect from a Medicare Advantage Plan?
With a Medicare Advantage Plan, you can expect additional benefits including prescription drug coverage, dental and vision coverage, hearing aids, fitness benefits, and other services such as mental health services.
→ How do I find Medicare Advantage Plans available in my area?
To find Medicare Advantage Plans available in your area, use Medicare’s Plan Finder Tool or contact State Health Insurance Assistance Programs (SHIPs) for more information.
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.