Humana vs Aetna Medicare Advantage Plans

Deciding on a Medicare Advantage Plan is crucial, and comparing Humana vs Aetna Medicare Advantage can guide your decision. This article breaks down their differences in benefits, costs, networks, and ratings.

Key Takeaways

• Aetna and Humana are major providers of Medicare Advantage Plans, offering services such as prescription drug coverage and additional benefits like dental and vision, with Humana available in 89% of U.S. counties and Aetna having a larger network with over 700,000 providers.

• Medicare Advantage Plans from both insurers include HMO, PPO, and SNP options, with Humana also providing specific chronic condition and dual-eligible SNPs in 2025, while Aetna focuses on in-network primary care and specialized chronic condition plans.

• Cost considerations for Medicare Advantage Plans include monthly premiums, with Humana averaging $18 and Aetna at $31.50, as well as other expenses like annual deductibles and maximum out-of-pocket costs, which are crucial for managing hospital and nursing services under Medicare Part A.

Overview of Humana and Aetna Medicare Advantage Plans

When it comes to Medicare Advantage Plans, Aetna and Humana are among the top private insurers in the market. Aetna, a CVS Health company, offers a broad range of services, including Medicaid services, across 46 states and Washington, D.C.

The company holds the fourth largest position among Medicare Advantage plan providers. Similarly, Humana’s Medicare Advantage Plans offer three categories – Medicare Advantage, Medicare Part D, and Medicare Supplement Insurance – providing coverage for areas not included in the government program like dental and vision care.

These Medicare Advantage Plans, also known as Medicare plans, are designed to supplement federal health insurance by providing coverage tailored to individual requirements, as opposed to generic plans intended for the broader population.

Both Humana and Aetna offer plans that provide coverage for expensive prescription drugs, offering a holistic approach to health insurance.

Comparing Plan Options: HMO, PPO, and SNP

Medicare Advantage Plans, available in diverse forms, accommodate various healthcare needs through their distinct features. The three main types of plans are Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, and Special Needs Plans (SNPs). But how do they differ, and which one is right for you?

Proceeding further, a comparative analysis of plan types offered by Aetna and Humana will be conducted.

Health Maintenance Organization (HMO) Plans

HMO plans offer maximum coverage when you seek medical care from a provider within the designated insurance network. It requires the selection of a primary care physician for routine health check-ups and for obtaining referrals to see specialists.

The majority of HMO plans typically cover a portion of out-of-network costs, with the main emphasis placed on in-network coverage.

Humana’s HMO Medicare Advantage plans integrate the comprehensive benefits of Medicare Parts A and B, predominantly offering coverage for prescription drugs. They often include supplementary benefits such as hearing, vision, and dental coverage.

Conversely, Aetna’s HMO Medicare Advantage plans stand out due to their focus on in-network primary care providers.

Preferred Provider Organization (PPO) Plans

PPO plans, such as those from Humana and Aetna, grant enhanced flexibility in choosing healthcare providers. They offer the following benefits:

• No requirement to select a primary care physician

• No need for referrals to consult with specialists

• Freedom to choose any preferred doctor or specialist

• Coverage for services received from out-of-network providers (although the coverage percentage is higher when you use in-network providers)

Indeed, PPO plans do cover expenses for both in-network and out-of-network providers. However, they offer a higher coverage percentage for expenses incurred when the insured seeks treatment from a doctor within the insurance network.

Special Needs Plans (SNPs)

Special Needs Plans are customized to cater to beneficiaries with specific healthcare needs and chronic conditions. Humana offers the following SNPs:

• C-SNPs for specific chronic conditions

• D-SNPs for dual-eligibility with Medicare and Medicaid

• I-SNPs, catering to conditions such as diabetes, cardiovascular disorders, chronic heart failure, and chronic lung disorders.

On the other hand, Aetna provides a DSNP for individuals dual-eligible for Medicare and Medicaid and highlights their Model of Care for coordinated care management for SNP members.

It is specifically designed for individuals with severe or disabling chronic conditions, including specific autoimmune disorders.

Extra Benefits and Perks

In addition to addressing basic healthcare needs, Original Medicare provides coverage for essential services, while Medicare Advantage Plans extend additional benefits, including extra perks. Health insurance plans frequently offer coverage for various services, including dental, vision, and prescription drugs.

Some Medicare Advantage plans may also provide additional perks like gym memberships and transportation to medical appointments, making them a comprehensive Medicare plan option.

Humana Medicare Advantage plans, for instance, offer an allocation for qualifying groceries, over-the-counter products, utilities, and rent, along with regular dental, vision, and hearing benefits.

Aetna Medicare Advantage plans, on the other hand, provide a range of benefits such as in-home health visits, meal delivery following a hospital stay, and financial assistance for dental, vision, and hearing care, in addition to other supplementary services.

Cost Comparison: Premiums, Deductibles, and Out-of-Pocket Expenses

The cost of Medicare Advantage Plans can be a decisive factor for many. Humana Medicare Advantage Plans average a $18 monthly premium, while Aetna Medicare Advantage Plans command an average monthly premium of $31.50.

However, premiums are just part of the cost equation. Beneficiaries are responsible for an annual deductible before Humana and Aetna commence covering healthcare expenses.

Every Medicare Advantage plan is equipped with a maximum out-of-pocket cost, representing the highest amount a beneficiary will be responsible for each year for covered healthcare services.

This cost sharing aspect is particularly important for hospital stays and nursing services under Medicare Part A, where there is a daily co-payment ranging from $176 to $704 per day.