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Humana Medicare Eligibility And Benefits

When Is The Best Time To Buy A Plan

VA Benefits and Medicare for Veterans – Humana

The Medicare Supplement Open Enrollment period starts on the 1st day of the 1st month in which youre age 65 or older and enrolled in Medicare Part B. In some states, you can buy a plan on the 1st day youre enrolled in Medicare Part B, even if youre not yet 65.

If you meet certain criteria, such as applying during your Medicare Supplement Open Enrollment Period, or if you qualify for guaranteed issue, a company cant use your medical history to determine your eligibility. Rules in some states may vary.

How Much Is The Medicare Deductible

In addition to premiums, plan members are also responsible for paying a deductible and coinsurance with Original Medicare. The 2022 deductible for inpatient hospital stays is $1,556 per benefit period. The annual deductible for Part B is $233. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services.

How To Enroll In Medicare

Medicare Part A and Medicare Part B are available to people:

  • Age 65 or older
  • Younger than 65 with a qualifying disability
  • With ESRD, permanent kidney failure requiring dialysis or a kidney transplant

There are certain times you can enroll in Medicare. To find out if youre eligible and calculate your Part B premium, use the Medicare.gov eligibility tool, opens new window. If you are eligible and need more information, try these tips on .

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Humana Medicare Advantage At A Glance

  • Plan options: Humana offers a wide range of Medicare Advantage plan options that cater to a variety of beneficiaries, including HMOs, PPOs and SNPs.
  • Provider network: The number of providers varies based on where you live. For example, there are 127,000 doctors contracted with Humana in northeastern Wisconsin.
  • Average monthly premium: Humana offers a number of plans with $0 monthly premiums. The average premium, however, is $19 per month.

What Do I Need To Know When Comparing Plans

Humana Medicare Supplement Plans

First, there are no provider networks with Medicare Supplement insurance plans. Plans can be used with any doctor or hospital that accepts Medicare. Second, the basic benefits offered by Plans A, B, C, F, G, K, L and N are the same from every insurance company. However, some companieslike Humanaalso offer additional benefits. Take some time to consider the differences is in the companies, the quality of service and the price.

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Humana Medicare Supplement Insurance Plans

Medicare Supplement Insurance plans like those offered by Humana work with Original Medicare and help pay Medicare out-of-pocket costs such as certain copayments, coinsurance and deductibles.

Medicare Supplement Insurance plans are standardized by the federal government and work with Original Medicare and Medicare stand-alone prescription drug plans. You cannot have a Medicare Advantage plan and a Medicare Supplement Insurance plan at the same time.

Humana offers eight Medicare Supplement Insurance plans in most states.5 Your plan options may vary depending on your state, including in Massachusetts, Minnesota and Wisconsin. Plans are standardized differently in those three states.

A licensed insurance agent6 can help you find out which Humana Medicare plan is right for your coverage needs. Simply call 1-855-298-6309 TTY Users: 711 24 hours a day, 7 days a week, or request a free plan comparison online, with no obligation to enroll in a plan.

Medical Providers: Please Use The Availity Provider Portal To Work With Us Online

The Humana.com secure medical provider portal was retired Oct. 26, 2018. Please work with us online via the Availity Provider Portal at Availity.com

To register for the Availity Portal, visit Availity.com and then click Register. For more information and training, visit Humana.com/ProviderSelfService.

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Do Medicare Plans Offer Prescription Drug Coverage

There are 2 ways to get Medicare prescription drug coverage:

  • You can choose a Medicare Advantage plan that includes prescription drug coverage .
  • You can purchase a called Part Dto add to your Original Medicare.

Your out-of-pocket costs for prescription drug deductibles, copays and coinsurance vary from plan to plan. Check each plans Drug List to see what prescription drugs are covered.

The History Of Medicare

Humana – Veteran’s Benefits

On July 30, 1965, President Lyndon B. Johnson signed into law the bill that led to Medicare and Medicaid. The original Medicare program included Part A and Part B , which are called Original Medicare today.1

Other important milestones include:2

  • 1966 Medicare was implemented and more than 19 million individuals enrolled by July 1.
  • 1972 Medicare eligibility was extended to individuals under age 65 with long-term disabilities and to individuals with ESRD.
  • 1980 Medicare Supplement insurance, also called Medigap, was brought under federal oversight.
  • 2001 The Health Care Financing Administration was renamed the Centers for Medicare & Medicaid Services .
  • 2003 The Medicare Prescription Drug, Improvement, and Modernization Act made the most significant changes to Medicare since the program began, including a new, optional, outpatient prescription drug benefit.
  • 2010 The Patient Protection and Affordable Care Act , commonly known as the Affordable Care Act, was signed into law and prohibited health insurance companies from denying or charging more for coverage based on an individuals health status.
  • 2013 The Health Insurance Marketplace opened and Americans were able to shop for health coverage without being denied or charged more because of a preexisting condition.

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Humana Offers Care Managers To Qualifying Plan Members

Some Humana Medicare Advantage plans may provide qualifying members with personalized care and support at home to help you recover from an injury or illness.

Depending on the plan, you may have access to professional caregivers who can help with:

  • Accessing home meal delivery and transportation services

The above coverage options are just a few of the extra benefits that certain Humana Medicare Advantage plans may be able to offer to qualifying members.

Again, its important to note that not all of these benefits are available with all Humana Medicare Advantage plans.

You can learn more about Humana Medicare Advantage plans and the possible extra benefits they may offer by discussing your options with a licensed insurance agent.1 You can call at 1-800-472-2986 TTY Users: 711 24 hours a day, 7 days a week, or you can request a free plan quote online, with no obligation to enroll in a plan.

What Is The Medicare Benefit Give

The Medicare Giveback Benefit, also known as The Part B Giveback, is a Part B premium reduction offered by some Medicare Part C plans.

If you enroll in a Medicare Advantage plan with this benefit, the plan carrier will pay some or all your Part B monthly premium. The amount covered can range from 10 cents to the total Part B premium cost .

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Are You Dual Eligible

Some people can be eligible for both Medicare and Medicaid at the same time.

Dual-eligible beneficiaries are individuals who are eligible for both Medicare and Medicaid.

People who are dual eligible share costs with state-run Medicare Savings Programs , which provide help with premiums, deductibles, coinsurance and copayments, depending on the participant’s income level and the specific MSP. There are programs where eligible participants may have no copayments or cost shares.

How Much Do Medicare Part A And Part B Premiums Cost

OPERS Health Care

Most people dont have to pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while they were working.

Theres also no premium for Part A if:

  • Youre receiving Social Security.
  • Youve received disability benefits for at least 24 months.

There is a monthly premium for Part B, which is deducted from your Social Security or, for those who receive them, from their Railroad Retirement Board benefits. For 2022, the standard premium for Part B coverage is $170.10 – or higher, depending on your income.1

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Can I Choose My Healthcare Provider

With Original Medicare, a primary care provider is not required. You can healthcare provider who accepts Medicare.

With a Medicare Advantage plan, your choice of doctor depends on whether you select a health maintenance organization or preferred provider organization plan.

With an HMO plan, you can choose your primary care doctor from any doctor in the plans network. If you opt for a PPO plan, generally, choosing a primary care doctor is optional. With both types of plans, youll usually save money by visiting an in-network provider.

Its important to note that Medicare Advantage plans must offer emergency coverage outside the plans service area, anywhere in the U.S.

What Does Original Medicare Cover

Original Medicare consists of Medicare Part A and Part B.

Medicare Part A generally covers inpatient hospital care, nursing facility care, nursing home care, hospice care and home healthcare.

Medicare Part B offers coverage for medically necessary and preventive care services. Essential medical services diagnose and treat health problems. It can include durable medical equipment , mental healthcare or ambulance services. Preventive care services are health treatments that prevent illness or detect problems early, like flu shots or cancer screenings.

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How Do I Sign Up For Medicare

In many cases, eligible individuals will automatically be enrolled others may need to apply for Medicare independently.

If this is the case, it is essential to sign up during the initial enrollment period , which is around your 65th birthday or 25th disability check.

You will have a 7-month period to browse options and sign up, including your birth month, the 3 months before, and the 3 months after your birth month.

If your birthday is the first of the month, you will be treated as if you were born the month before your birth month.

Qualifying For Different Types Of Coverage

Humana: How to choose a Medicare Plan that’s right for you

Medicare is a federal insurance program that helps pay medical bills from a fund to which users have contributed. It covers people 65 and older, people younger than 65 with certain disabilities and patients with end-stage kidney disease and other conditions requiring dialysis. Participants usually pay part of the cost.

Medicaid is an assistance program provided jointly by federal and state agencies. It helps with medical expenses for eligible people with limited income and resources.

There are different rules for each state, but in most states, you may be eligible for Medicaid if you are under certain income levels and/or are:

  • A parent or adult caring for a child
  • An adult with dependent children
  • An eligible immigrant

Participants usually pay nothing for covered medical costs, although they may sometimes be responsible for a small copayment or cost share.

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The Basics Of Medicare

There are 4 different parts of Medicare:

Original Medicare Part A helps cover inpatient hospital care, skilled nursing care, hospice care and home healthcare. Generally, if you have worked and paid Medicare taxes for the past 10 years, you don’t pay a monthly premium for Original Medicare Part A.

Original Medicare Part B helps cover medical visits with doctors and other healthcare providers, outpatient care, home healthcare, durable medical equipment and some preventive services. Most participants pay a monthly premium for Original Medicare Part B.

Part C helps cover services provided for under Original Medicare Part A and Part B and may include prescription drug coverage . Part C is run by Medicare-approved private insurance companies.

Part D helps cover the cost of prescription drugs and may help lower the amount you pay for prescriptions. It’s run by Medicare-approved private insurance companies.

Visit Medicare.gov, opens new window for more information.

Types Of Medicare Plans

Some links on this page may take you to Humana non-Medicare product or service pages or to a different website.

This information is provided for educational purposes only. It is not to be used for medical advice, diagnosis or treatment. Consult your healthcare provider if you have questions or concerns.

Consult your doctor before beginning any new diet or exercise regimen.

This communication does not guarantee benefits and does not indicate all services received will be covered by your plan. Please refer to your Evidence of Coverage or call Customer Service at the number on the back of your Humana ID card to confirm that the service will be covered by your plan.


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Silversneakers Memberships Are Available With Many Plans

Humana has partnered with SilverSneakers® Fitness to give Medicare Advantage beneficiaries unlimited and unrestricted access to more than 15,000 fitness locations nationwide at no extra cost.

Some exceptions apply, and this service is not available on all Humana Medicare Advantage plans.

If your Humana Medicare Advantage plan includes SilverSneakers membership, your access to participating fitness locations can include:

  • Access to cardio equipment and free weights
  • Fitness classes led by certified instructors
  • Social events that can allow you to connect with other members

SilverSneakers also offers at-home kits for members who want to start working out at home or for members who cant get to a fitness location due to injury, illness or other reasons that keep them homebound.

Understand Your Coverage Options

Is Humana And Medicare The Same: November 2017

Even if you’re under 65, you may still qualify for Medicare benefits. Most people assume you must be 65 to sign up for Medicare, but there are exceptions:

  • If you’re under age 65 and youve received disability benefits from Social Security or the Railroad Retirement Board for at least 24 months, youll automatically get Medicare Part A and Part B
  • If you’re a disabled federal, state or local government employee who is not eligible for Social Security or Railroad Retirement Board benefits, you may be eligible for Medicare 24 months after you qualify for disability

Most people whove worked and paid taxes for a certain amount of time dont have to pay a premium for Medicare Part A .

With Part B, which covers things like doctor visits, lab tests and preventive services, most people have to pay a monthly premium. In 2022, the monthly Part B premium is $170.10 .

If youre disabled but still covered under your own or a qualified family members employer plan, you may want to keep that coverage and postpone enrolling in Medicare Part B to postpone paying the premium. Your Part B premium won’t begin until your Part B benefits do.

Learn about

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Humana For Physicians And Healthcare Providers

Our members health is in your hands. Thats why Humana is committed to supporting your practice with training resources, policy updates, and industry-leading patient care programs. And with Availity, you can conduct business online quickly and easily, so you can focus on the well-being of our members.

Confirm Your Enrollment Period

The Initial Enrollment Period is your first chance to sign up for Medicare. Once you become eligible, you have these 7 months to enroll:

  • 3 months before the month you turn 65
  • The month you turn 65
  • 3 months after the month you turn 65

Note: If you dont sign up during your IEP, you may face a late enrollment penalty.

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Do Humana Medicare Advantage Plans Offer Routine Dental Coverage

Certain Medicare Advantage plans from Humana may offer routine dental benefits not covered by Original Medicare. Your dental coverage depends on which Humana Medicare Advantage plan you have.

Humana offers a range of Optional Supplemental Benefits that you may be able to add to your Humana Medicare Advantage plan for an additional monthly premium.

The OSBs offered by Humana can include coverage for dental needs such as:

  • Routine cleanings and exams

Some, but not all, Humana Medicare Advantage plans offer dental coverage. If you are enrolled in a Medicare Advantage plan with dental coverage, your insurance provider will detail what dental services are included and what each service costs.

Can I Use Medicare Everywhere In The Us

Enrolling in Medicare? Humana has answers for your questions

Medicare is widely accepted across the U.S., but its not universal. Original Medicare provides nationwide coverage, whereas Medicare Advantage plans have provider networks that can be limited to a local area. When reviewing plan options from private health insurers, pay close attention to which providers in your area accept Medicare to ensure that you have access to care when you need it.

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Do Humana Medicare Advantage Plans Offer Prescription Drug Coverage

Many Humana Medicare Advantage plans may offer prescription drug coverage that is equal to or better than that of a standalone Medicare Part D plan.

Members can choose from a wide range of in-network pharmacies and may even be able to have their prescriptions mailed right to their home.

Not all Humana Medicare Advantage plans offer prescription drug coverage, and benefits may vary from plan to plan. Your insurance provider will detail what medications are covered, the plans drug list and how much it will cost to fill your prescriptions.

Humana Medicare Advantage Plans

Like all Medicare Advantage plans, Humana Medicare Advantage plans provide the same coverage as Original Medicare , and some plans may include additional benefits coverage, such as:

  • Prescription drug coverage

Certain Humana Medicare Advantage plans also offer other benefits such as fitness programs, access to mail-order pharmacy services, and caregiver support.3

You may be able to enroll in a plan with an affordable or, in some areas, a $0 monthly premium.1

Over 5 million people are enrolled in a Humana Medicare Advantage plan.2

Humana offers four Medicare Advantage plan types:

  • Humana HMO plans
  • Humana PFFS plans
  • Humana Medicare Advantage Special Needs Plans
  • A Humana HMO plan requires you to choose an in-network primary care doctor. The plan offers affordable copayments and generally has a lower out-of-pocket maximum than Humanas PPO and PFFS plans.

    A Humana PPO plan lets you visit any Medicare-approved doctor who accepts Humanas plan terms and agrees to bill the plan. The plan offers affordable copayments and has mid-range out-of-pocket maximum compared to Humanas HMO and PFFS plans.

    A Humana PFFS plan lets you visit almost any Medicare-approved doctor who accepts Humanas plan terms and agrees to bill the plan. The plan offers affordable copayments and has a higher-range out-of-pocket maximum compared to Humanas HMO and PPO plans.

    Your plan options may vary depending on your location.

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