Medicare vs Humana Advantage Plans

Navigating the world of Medicare can feel like navigating a labyrinth. With a myriad of options at your disposal, deciding between Original Medicare and Humana Medicare Advantage can seem daunting.

But fear not, this comprehensive guide will illuminate the path, shedding light on the key differences and similarities between Medicare and Humana Advantage plans. Embark on this journey with us as we dissect the intricacies of these two healthcare options, equipping you with the knowledge necessary to make the best decision for your health.

 

Key Takeaways

 

 

  • The costs of both plans should be evaluated to determine which fits an individual’s budgeting needs best.

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Understanding Medicare and Humana Medicare Advantage

Healthcare needs vary greatly among individuals. Medicare, a federal health insurance program, accommodates these diverse needs by providing coverage to people aged 65 and older, as well as those with specific disabilities and conditions.

The core of Medicare, often referred to as Original Medicare consists of Part A and Part B which cover hospital care and outpatient services respectively. However, Medicare extends its services beyond this initial scope, offering alternative options for your consideration.

 

Understanding Medicare and Humana Medicare Advantage

One such route is the Medicare Advantage Plan, an alternative to Original Medicare offered by private companies. Humana, a leading provider of Medicare Advantage Plans, has carved a special niche in this realm.

Humana Medicare Advantage plans, often providing coverage for care not included in the original option, such as dental, vision, and hearing care, offer a value-packed alternative to Original Medicare.

With multiple options such as Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans, Humana provides custom plans to meet the diverse needs of individuals.

 

Original Medicare Explained

Being a long-standing institution, Original Medicare has been providing basic healthcare coverage for over fifty years. Signed into law by President Lyndon B. Johnson in 1965, Original Medicare was designed to ensure healthcare coverage for all eligible individuals, regardless of age, disability, or sex.

Today, Original Medicare continues to provide basic healthcare coverage, encompassing Part A (hospital care), Part B (doctor visits, lab tests, and other outpatient services), and Part D (prescription drugs).

Those with a disability or End-Stage Renal Disease also qualify for Original Medicare, extending eligibility beyond age criteria, irrespective of their disability, sex, sexual orientation, or geographical location.

Original Medicare, with its broad eligibility and extensive coverage, provides a robust healthcare foundation. Yet, it does have certain limitations. For instance, prescription drug coverage is not included in Original Medicare’s package, requiring individuals to purchase a Medicare Part D plan from a private insurer or a Medicare Supplement insurance plan to gain access to this coverage.

 

Humana Medicare Advantage Breakdown

 

Why medicare advantage plans are bad Humana Medicare Advantage offers a modern alternative to traditional Medicare.

As a private insurance plan, Humana Medicare Advantage expands upon the benefits of Original Medicare, catering to a diverse range of individuals.

 

With the evolving healthcare landscape, the federal government has been diversifying the services that Medicare Advantage plans can offer, ranging from acupuncture to meal delivery.

Within Humana Medicare Advantage, Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most popular options.

These popular plans offer a tailored approach to healthcare, accommodating a diverse range of individuals, regardless of their sexual orientation gender identity, expression of transgender status marital.

Furthermore, Medicare Advantage plans, such as those offered by Humana, often provide robust prescription drug coverage and access to cost-effective preferred pharmacies, making them an attractive alternative to Original Medicare.

Coverage Face-off: Original Medicare vs Humana Medicare Advantage

Coverage is typically the primary consideration when choosing a healthcare plan. Both Original Medicare and Humana Medicare Advantage provide coverage for preexisting conditions and prescription drugs, as they are both under the Medicare contract. However, the extent and type of coverage differ between the two.

Original Medicare offers basic coverage for hospital and medical services, serving as a safety net for healthcare needs. On the other hand, Humana Medicare Advantage plans often go a step further, offering more comprehensive coverage and additional benefits. Some individuals may also choose to purchase a Medicare Supplement plan to help cover costs not covered by Original Medicare.

 

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Thus, the choice between Original Medicare and Humana Medicare Advantage hinges on the individual’s healthcare needs and preferences, as Medicare evaluates plans based on various factors.

 

Prescription Drug Coverage

Prescription drug coverage serves as a key distinguishing factor between Original Medicare and Humana Advantage. Original Medicare does not offer prescription drug coverage as a part of its coverage package.

This means that individuals looking to cover prescription drug costs would need to purchase a Medicare Part D plan from a private insurer or a Medicare Supplement insurance plan.

In contrast, Humana Medicare Advantage plans often include prescription drug coverage as part of their benefits, making them a viable option for those seeking prescription drug plans. The plan includes a formulary, which is a list of the most commonly prescribed drugs covered by Humana and is regularly updated by physicians and other providers.

For individuals who require regular prescription medications, Humana Advantage’s integrated prescription drug coverage, along with lower-cost preferred pharmacies, could tip the scales in its favor.

 

Extra Benefits with Humana

Humana Advantage plans offer an array of additional benefits beyond prescription drug coverage.

 

Humana medicare advantage ppo These plans often provide coverage for care not included in Original Medicare, such as dental coverage, vision, and hearing care.

From the potential for prescription savings to routine dental and vision coverage, the additional benefits offered by Humana Advantage plans contribute to a comprehensive healthcare package.

Humana Advantage benefits include a variety of wellness programs. These include the Go365 well-being & rewards program, Sharecare for managing health and wellness, and SilverSneakers for health and fitness.

 

These programs, combined with regular dental and vision coverage, make Humana Advantage a formidable contender in the face-off with Original Medicare.

Cost Comparison: Understanding Your Healthcare Spending

Cost is a significant consideration when sifting through various healthcare options. Understanding the cost structure of both Original Medicare and Humana Advantage is pivotal for making an informed decision. Original Medicare and Humana Advantage have different approaches to healthcare spending.

 

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Unlike Original Medicare, which doesn’t impose an annual limit on out-of-pocket costs, Medicare Advantage plans set a yearly cap on such expenses. Also, a less expensive plan may lead to higher out-of-pocket costs during doctor’s visits.

Therefore, the decision between Original Medicare and Humana Advantage often involves striking a balance between monthly premiums and out-of-pocket costs.

 

Breaking Down Original Medicare Costs

Original Medicare operates on a fixed cost structure, consisting of premiums, deductibles, and copayments.

The typical monthly premium for Original Medicare Part B in 2024 is $174.70. In addition to premiums, Original Medicare also includes an annual deductible for inpatient hospital stays and may have coinsurance or copayments for extended stays.

While Original Medicare provides a wide safety net of coverage, it does not cover all health costs. There could be other costs for services not covered by Original Medicare, such as:

 

  • Prescription drugs
  • Dental care
  • Vision care
  • Hearing aids
  • Long-term care

 

Hence, being aware of Original Medicare’s cost structure and potential healthcare costs is key for effective financial planning.

 

Evaluating Humana Advantage Plan Costs

Humana Advantage plans, on the other hand, may offer lower out-of-pocket costs and annual spending caps through cost sharing. These plans feature an annual maximum out-of-pocket limit. Upon reaching this limit, no further payment is required for covered services for the remainder of the plan year.

However, Humana Advantage plans come with varying costs. The projected average premium for a plan in 2024 is estimated to be $18.50 per month. Additionally, there may be other costs such as deductibles, coinsurance, and copayments associated with the plan.

Grasping the cost structure of Humana Advantage plans can aid in budgeting for healthcare costs and choosing a plan that best suits your needs.

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Network Nuances: Provider Access and Flexibility

Provider networks play a significant role when comparing Original Medicare and Humana Advantage. These networks determine which healthcare providers you can see and may impact your healthcare choices and costs.

Original Medicare provides you with the flexibility to access care from any provider in the U.S. that accepts Medicare. This means you can get the care you need no matter where you travel in the country. Hence, you can consult any provider accepting Medicare, irrespective of your geographical location.

On the other hand, Humana Advantage plans typically provide access to a network of providers within a specific geographic area. Therefore, the choice between Original Medicare and Humana Advantage may depend on your provider preferences and healthcare needs.

 

Original Medicare’s Wide Network

Original Medicare provides access to an extensive network of providers. This network provides beneficiaries with the freedom to select any doctor or hospital that accepts Medicare. It does not necessitate referrals or prior authorization for specialist care, providing flexibility and choice for beneficiaries.

 

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Despite Original Medicare’s extensive network, there could be potential limitations. For instance, while you can see any provider who accepts Medicare, not all providers do. Therefore, it is important to confirm that your healthcare provider participates in the Medicare program before receiving services.

 

Humana’s Network Parameters

In contrast, Humana Advantage plans might have more restricted networks. These plans employ a network of participating or preferred healthcare providers. While this may limit the choice of providers, it can also lead to lower costs and coordinated care.

However, Humana Advantage plan members may need to utilize in-network providers. It is suggested to contact Humana to identify a doctor within the network. Therefore, the choice between Original Medicare and Humana Advantage may depend on your preference for provider choice versus cost savings and coordinated care.

Enrollment and Eligibility: Joining Medicare or Humana Advantage

Enrollment and eligibility for healthcare plans might seem complex. Understanding the enrollment process for Original Medicare and Humana Advantage is essential for a seamless transition to your selected plan.

To be eligible for Original Medicare, you must meet one of the following criteria, regardless of your national origin age disability:

 

  • Be 65 years of age or older
  • Be a U.S. citizen or permanent legal resident for a minimum of five consecutive years
  • Have a disability
  • Have End-Stage Renal Disease

 

To be eligible for Humana Advantage, you must:

 

  • Be enrolled in both Medicare Part A and Part B
  • Reside in the service area of the plan you wish to join, including rural areas
  • Not have end-stage renal disease (ESRD) with some exceptions.

 

How to Enroll in Original Medicare

Enrolling in Original Medicare is a straightforward process. The Initial Enrollment Period (IEP) for Original Medicare is a 7-month period that commences 3 months before and after an individual’s 65th birthday. During this period, individuals can sign up for Original Medicare.

To enroll in Original Medicare, you may need to provide the following documents:

 

  • Birth certificate
  • Proof of U.S. citizenship or legal residency
  • Social Security card
  • Health insurance information (if applicable)
  • Driver’s license or passport

 

By preparing these documents in advance, you can ensure a smooth and stress-free enrollment process.

 

Signing Up for Humana Medicare Advantage

Joining a Humana Advantage plan involves choosing a specific plan and enrolling during designated periods. The designated enrollment periods for Humana Advantage Plans are the Annual Enrollment Period (AEP) from October 15th to December 7th and the Medicare Advantage Open Enrollment Period (MA OEP) from January 1st to March 31st.

 

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To enroll in a Humana Advantage plan, you need to complete a form with your personal information, such as your date of birth, address, and Medicare number. Alternatively, you can register with your member ID or Medicare ID, date of birth, and ZIP code.

With this information at hand, you can easily navigate the enrollment process for Humana Advantage.

Tailoring Your Choice: Which Plan Suits You Best?

The decision between Original Medicare and Humana Advantage isn’t a one-size-fits-all solution. It involves carefully considering your healthcare needs and financial situation. The decision-making process involves a delicate balance between assessing your healthcare needs and weighing the costs and benefits of each plan.

 

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Healthcare needs can significantly impact the decision between Original Medicare and Humana Advantage. Coverage, network, cost, and flexibility are all important considerations. Original Medicare provides basic coverage, while Humana Advantage plans may offer additional benefits.

Hence, your specific needs and preferences should guide your choice between Original Medicare and Humana Advantage.

 

Considering Your Health Care Needs

When choosing a healthcare plan, your personal healthcare needs should be at the forefront of your decision-making process. The most commonly experienced health needs among Medicare beneficiaries are:

 

  • Hypertension
  • High cholesterol
  • Heart disease
  • Diabetes

 

Therefore, considering your current and potential future health needs can help you select a plan that provides the best coverage for your situation.

Chronic illnesses, for instance, can significantly influence the decision between Original Medicare and Humana Advantage.

Humana Advantage plans, including C-SNPs (Chronic Special Needs Plans), are specifically designed to support individuals with chronic conditions and provide tailored benefits to meet their healthcare needs. Therefore, considering your healthcare needs can help you select a plan that provides the right coverage for your situation.

 

Weighing Costs and Benefits

 

Weighing Costs and Benefits

 

Weighing the costs and benefits of each plan can help you determine which option provides the best value for your situation.

Original Medicare provides a wide safety net of coverage but does not cover all health costs. There could be other costs for services not covered by Original Medicare, such as prescription drugs.

On the other hand, Humana Advantage plans come with varying costs. The projected average premium for a plan in 2024 is estimated to be $18.50 per month. Additionally, there may be other costs such as deductibles, coinsurance, and copayments associated with the plan.

Therefore, understanding the cost structure of Humana Advantage plans can help you budget for your healthcare costs and select a plan that provides the best value for your needs.

Summary

Navigating the world of Medicare can feel like navigating a labyrinth, but with the right guide, it doesn’t have to be. Whether you choose Original Medicare or Humana Advantage, the most important thing is to select a plan that meets your healthcare needs and financial situation.

From coverage and costs to provider networks and enrollment processes, understanding the nuances of each plan can empower you to make an informed decision. So, move forward with confidence, knowing that you have the knowledge to navigate the labyrinth of Medicare and select the best plan for your needs.

Frequently Asked Questions

 

 

What is the difference between Medicare and Humana Medicare Advantage?

Medicare Advantage is an alternative to traditional Medicare that is offered by private health insurance companies and includes the same services as Original Medicare Part A and Part B, as well as additional benefits such as prescription drug coverage.

 

What is the biggest disadvantage of Medicare Advantage?

Medicare Advantage plans can often limit access to providers and may have higher out-of-pocket costs, making them a less attractive option for some seniors.

 

Why are people leaving Medicare Advantage plans?

People are leaving Medicare Advantage plans due to high denial rates and slow payments from insurers, as well as allegations of billing fraud from the federal government.

 

Does Original Medicare cover prescription drugs?

Original Medicare does not provide prescription drug coverage, but individuals can purchase additional plans to get the coverage they need.

 

How do I enroll in Original Medicare or Humana Advantage?

To enroll in Original Medicare, use the Social Security portal or contact them directly. To join Humana Advantage, fill out a form with your personal information during the designated enrollment periods.

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 ZRN Health & Financial Services, LLC, a Texas limited liability company

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Speak with a licensed insurance agent

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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.