Is Humana Choice PPO a Medicare Advantage Plan?

If you’re considering a Medicare Advantage Plan, you’ve probably come across the question, “Is Humana Choice PPO a Medicare Advantage Plan?”

Humana Choice PPO is widely recognized for offering comprehensive coverage and flexibility, but what does that truly mean for you? Let’s unravel the specifics.


Key Takeaways


  • It provides flexibility in provider choice but may come at a higher cost for out-of-network services than other plans.


  • When selecting a plan, it is important to evaluate factors such as network, costs, coverage options, and quality ratings before making the right decision.

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What is Humana Choice PPO?

In the sphere of Medicare Advantage plans, including Medicare advantage HMO PPO options, Humana Choice PPO is a prominent choice. This plan is a unique blend of flexibility and comprehensive coverage, designed to cater to a wide range of healthcare needs.

Operating as a Preferred Provider Organization (PPO), Humana Choice PPO allows you to receive care from any healthcare provider, within or outside the network, without the need for a referral.

This Humana plan not only offers the same benefits as Original Medicare (Part A and Part B), but it also includes prescription drug coverage and routine dental, vision, and hearing care.

What’s more, it boasts extra benefits like telehealth services and wellness programs. Some Humana plans may also coordinate with state Medicaid programs for eligible individuals, including the state Medicaid program.

However, keep in mind the costs, which may include copays, coinsurance, deductibles, and both in-network and out-of-network out-of-pocket maximums. The availability of lower-cost preferred pharmacies within the plan’s network can help reduce prescription drug costs.


Plan Structure


Is Humana Choice PPO a Medicare Advantage Plan?,Plan Structure


The structure of Humana Choice PPO includes the following features:

  • Members can access any provider within the network without referrals


  • Out-of-network providers are also accessible but at an increased cost


  • In-network providers have a contractual agreement with the insurance company to accept reduced rates


  • Out-of-network providers may not offer the same discounted rates


This plan does away with the need for referrals, allowing you to visit any doctor, specialist, or hospital of your choice. It’s worth noting, however, that charges may exceed the plan’s maximum allowable fee, which you would be responsible for.

Therefore, consulting the provider directory to check which providers are in-network is recommended. The use of out-of-network providers may lead to higher total costs.


Coverage Offered



Is Humana Choice PPO a Medicare Advantage Plan?, Coverage Offered

Humana Choice PPO offers comprehensive coverage that includes medical, hospital, and prescription drug benefits. It also provides optional dental, vision, and hearing coverage for an all-encompassing healthcare package.

From doctor visits to hospital stays, prescription drugs, and preventive care, Humana Choice PPO ensures you’re covered with comprehensive health care.

Some Humana plans, such as Humana USAA Honor plans, are tailored to cater to the needs of military veterans and their families.

Coverage for hospital stays allows you to select a doctor that best meets your medical requirements. Prescription drugs included in Humana Choice PPO are listed in the Prescription Drug Guide available on the Humana website.

The plan also provides optional dental coverage as a supplemental benefit, offering extra dental coverage such as yearly exams, cleanings, and X-rays, along with an integrated Rx plan.

Is Humana Choice PPO a Medicare Advantage Plan?

Yes, Humana Choice PPO is indeed a Medicare Advantage Plan. These plans are offered by private companies that contract with Medicare to provide all Part A and Part B benefits.

Humana Choice PPO stands out by combining Original Medicare benefits with extra services and coverage, providing a comprehensive health plan that caters to a wide range of needs.

To be eligible for Humana Choice PPO, you need to be enrolled in Medicare Part A and Part B, reside within the service area of the plan, and not have end-stage renal disease (ESRD), with some exceptions.

If you meet these conditions, you can benefit from the coverage offered by Humana Choice PPO, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), along with additional benefits and services for special needs individuals, regardless of their ethnicity of disability.


How It Works

Humana Choice PPO operates by providing comprehensive coverage through a network of providers. This allows you access to a wide range of healthcare professionals, also referred to as ‘participating providers’, that can help meet your healthcare needs.

The plan also offers the option to use out-of-network providers, albeit at a higher cost. This means you can receive healthcare services from providers who have not contracted with the Humana Choice PPO plan.

While this provides you with increased flexibility, it may result in elevated out-of-pocket costs.

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Comparing Humana Choice PPO to Other Medicare Advantage Plans

Is Humana Choice PPO a Medicare Advantage Plan?,Comparing Humana Choice PPO to Other Medicare Advantage Plans

To fully comprehend the value of Humana Choice PPO, you should compare it with other Medicare Advantage plans. Grasping the subtleties between different plans can assist you in making a conscious decision.

The benefits of Humana Choice PPO include the flexibility to choose providers and comprehensive coverage. However, potential drawbacks may include higher costs for out-of-network services and limited availability in some areas.

In comparison to other Medicare Advantage plans, Humana Choice PPO offers increased flexibility in provider choice. This plan allows you to use providers both in and out of the network without a referral, giving you more options for healthcare providers.

However, this flexibility comes with higher monthly premiums.

Humana Choice PPO plans, a type of Humana Medicare advantage plan, offer the following features:

  • Typically more costly than other Medicare Advantage plans


  • Provide more comprehensive coverage


  • Balanced by potentially elevated costs for out-of-network services due to the added flexibility offered by the plan.


Pros and Cons

Every plan has its strengths and weaknesses, and Humana Choice PPO is no exception. On the bright side, this plan offers several advantages, such as:


  • The option to receive care from out-of-network providers


  • Increased flexibility in selecting providers


  • A diverse range of highly rated plans


On the flip side, some potential drawbacks to consider include:

  • Restricted network options


  • Unavailability of Special Needs Plans (SNPs)


  • The potential cost of out-of-network services in Humana Choice PPO can vary and may be higher than those of other plans


Overall, the benefits of flexibility in provider choice and comprehensive coverage are balanced against potential higher costs for out-of-network services and limited availability in some areas.

Costs Associated with Humana Choice PPO

When considering Humana Choice PPO, it’s imperative to comprehend the associated costs. These costs may vary by plan and location. Some plans offer $0 premiums; however, members are still required to pay the Medicare Part B premium.

The Medicare Part B premium is a monthly fee that must be paid to sustain coverage. This premium is separate from the plan premium and must be paid to maintain coverage.

To compare the costs of Humana Choice PPO with other plans, you can use Medicare’s plan-finding tool.


Understanding Medicare Part B Premiums

Comprehending Medicare Part B premiums is significant when considering Humana Choice PPO. For 2023, the Medicare Part B premium is a minimum of $164.90 per month, increasing to $174.70 per month in 2024.

The cost of Medicare Part B premiums is determined by one’s income level and the percentage of the total cost of Part B that they are required to pay, based on their income reported to the Internal Revenue Service.

These premiums are adjusted annually. If a Medicare Part B premium is not paid, there is a potential for loss of coverage. However, Medicare provides notifications and offers the opportunity to pay the overdue amount prior to termination of coverage.


Extra Benefits and Services

One of the standout features of Humana Choice PPO is the array of additional benefits and services it provides. These include fitness programs, telehealth services, and care coordination, all designed to enhance your wellness journey.

The SilverSneakers fitness program is one of the extra benefits offered by Humana Choice PPO, which encourages active and healthy living. Telehealth services provide 24/7 access to medical doctors and behavioral health specialists by appointment, both via telephone and video visits.

Care coordination services, including appointment scheduling, medication management, health education, and coaching, are also provided, ensuring that your healthcare needs are efficiently managed.

Evaluating Humana’s Medicare Advantage Ratings


Is Humana Choice PPO a Medicare Advantage Plan?,Evaluating Humana's Medicare Advantage Ratings

When evaluating a Medicare Advantage Plan, the quality ratings of the plan are significant. Humana’s Medicare Advantage plans have received high ratings for quality and member satisfaction.

The National Committee for Quality Assurance (NCQA) rates Humana plans on a 5-point scale, with ratings ranging from 2.5 to 4.0 stars. For those considering plans in MD, ME, MI, MN, or other states, it’s essential to research and compare the available Medicare Advantage options.

Humana has 25 contracts rated 4 stars or higher (out of 5) for 2024, and four contracts have been awarded 5 stars. As of October 2023, Humana’s Medicare Advantage members in rated contracts greatly surpass the industry standard.

92% were in 4-star or higher contracts. This is an impressive feat considering the average star rating for plans from all providers in 2024 is 4.04.


Availability and Service Area

Humana Choice PPO is available in 94% of U.S. counties, guaranteeing broad coverage. Humana offers Medicare Advantage plans in 49 states, including CA, CT, DC, DE, and Puerto Rico. This ensures its services are easily reachable for many people.

However, bear in mind that the availability of Humana Choice PPO might change based on your exact location. So, while Humana’s coverage is extensive, it’s always a good idea to check whether the specific plan you’re interested in is available in your area.

Customer Support and Resources


Is Humana Choice PPO a Medicare Advantage Plan?, Availability and Service Area


Humana is committed to providing exceptional customer service and support. In fact, as a Humana insurance company, it is ranked first in terms of customer experience quality among health insurers.

Humana members may contact customer service by calling a toll-free number or utilizing online chat after logging into their account.

Beyond just customer support, Humana provides resources to assist members in making informed decisions regarding their healthcare.

For non-members interested in learning more about Humana’s Medicare Advantage plans, they can contact Humana’s customer support or visit their website to learn more about the plans and eligibility requirements.


Making the Right Decision: Factors to Consider

Selecting a Medicare Advantage Plan is a substantial decision that needs meticulous consideration. When selecting a plan, essential elements to consider include:

  • Network


  • Costs


  • Coverage


  • Prescription drug coverage


  • Quality ratings


  • Flexibility


  • Extra benefits


With its competitive pricing and extensive coverage, Humana Choice PPO can be a compelling option. It provides a vast network of providers, comprehensive coverage, and competitive pricing.

The average premium for a Medicare Advantage plan in 2024 is $18.50 per month, and Humana offers a range of $0-premium plans in many states. However, it’s crucial to understand the potential drawbacks, such as restricted network options and the unavailability of Special Needs Plans (SNPs), and weigh them against the benefits.


In conclusion, Humana Choice PPO stands out as a robust Medicare Advantage plan, offering comprehensive coverage and flexibility. It provides access to a vast network of providers and offers additional benefits that enhance your healthcare journey.

However, like any plan, it has its potential drawbacks, such as higher costs for out-of-network services and limited availability in some areas. Therefore, while Humana Choice PPO can be an attractive option, it’s crucial to consider your specific healthcare needs, costs, and the plan’s availability in your location before deciding.


Frequently Asked Questions


→  Is a Medicare PPO the same as an Advantage plan?

A Medicare PPO is a type of Medicare Advantage Plan that includes network doctors, specialists, hospitals, and other healthcare providers, providing the same benefits, rights, and protections as Original Medicare.


→  What are 4 types of Medicare Advantage plans?

Medicare Advantage plans come in three main types: Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, and Private Fee-for-Service (PFFS) plans.


→  What is the Medicare Part B premium for Humana Choice PPO?

The Medicare Part B premium for Humana Choice PPO is a minimum of $164.90 per month in 2023, increasing to $174.70 per month in 2024. This premium must be paid separately from the plan premium to maintain coverage.


→  What additional benefits does Humana Choice PPO offer?

Humana Choice PPO provides additional benefits like SilverSneakers fitness, telehealth services, and care coordination to help you get the most out of your coverage.


→  How does Humana’s Medicare Advantage ratings compare to other plans?

Humana has consistently scored higher in ratings compared to other Medicare Advantage plans, with 25 contracts rated 4 stars or higher and four contracts awarded 5 stars for 2024.

As of October 2023, 92% of its members were in contracts rated 4 stars or higher.

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Russell Noga
( Medicare Expert )

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.