Humana offer Part D prescription drug coverage with some of their Medicare Advantage plans. They also provide three standalone Part D options.
Medicare Advantage plans are a private insurance alternative to original Medicare (Part A and Part B). Medicare Advantage plans generally offer additional benefits, such as prescription drug and wellness benefits.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Humana are a for-profit insurance provider with headquarters in Louisville, KY. They operate in all 50 states, plus Washington, D.C., and Puerto Rico.
Humana offer Medicare Advantage plans that provide at least the same coverage as original Medicare (parts A and B). However, unlike original Medicare, many Humana Medicare Advantage plans offer dental, vision, hearing, and prescription drug coverage.
Humana offer several Medicare Advantage plan types, including:
- Health Maintenance Organization (HMO) plans
- Preferred Provider Organization (PPO) plans
- Private Fee-for-Service (PFFS) plans
- Special Needs Plans (SNPs)
Humana HMO plans
A requirement of Humana HMO plans is that people use the company’s network of providers. People must also choose a primary care doctor as their first point of contact. This doctor will provide referrals to see specialists.
Some Human HMO plans have $0 premiums.
Humana PPO plans
The Humana Choice PPO plan does not require people to nominate a doctor or request specialist referrals. However, although a person can visit any Medicare-approved doctor, visiting an out-of-plan provider may result in higher costs.
Humana PFFS plans
With Humana’s Gold Choice PFFS plan, members are free to visit any Medicare-approved doctor who accepts Humana’s terms. People need not choose a primary care doctor, and they do not require specialist referrals.
Most Humana PFFS plans include Part D prescription drug coverage.
Individuals can qualify for Humana SNPs if they have a chronic disabling condition or qualify for both Medicare and Medicaid.
Humana SNPs do not have premiums, copays, or coinsurance.
All Humana Medicare Advantage SNPs and most of their HMO plans include drug coverage. Some PPO and PFFS plans also include this benefit. In addition, a person can choose a standalone prescription drug plan.
People taking several medications with various prescriptions might benefit from the Humana Medication Therapy Management program. People can meet with a doctor or pharmacist to learn about their prescription medications, ask questions, and explore opportunities to lower their costs.
This online tool can help people search for Humana plans.
Standalone Part D plans
Humana offer several standalone Part D plans:
- Humana Walmart Value Rx Plan: With this plan, members can save on generic medications and use over 9,000 cost-sharing pharmacies nationwide.
- Humana Premier Rx Plan: This is Humana’s most comprehensive Part D plan. It has an extensive formulary.
- Humana Basic Rx Plan: This plan offers basic coverage, and people can access the preferred cost-sharing network.
Humana Medicare Part D plans, much like other Part D plans, use a formulary. This is a list of covered medications divided into tiers.
Typically, the lower-tier drugs include generics that cost less than brand-name and specialty medications, which are typically in the upper tiers.
Humana formularies generally include around 3,500 different drugs. Providers can decide which drugs to include, but Medicare rules state that each Part D plan covers a minimum of two medications from each of these six categories:
- anticancer drugs (unless under Medicare Part B coverage)
- anticonvulsive treatments for seizure disorders
- antipsychotic medications
- HIV and AIDS treatments
- immunosuppressant medications
Part D plans must also cover all commercially available vaccines, except those that Medicare Part B covers, such as the annual flu shot.
Costs for Humana Medicare Advantage and Part D plans vary according to several factors. These include the following:
Both Medicare Advantage plans and Part D plans have monthly premiums, though in some cases, this could be $0. A person who is enrolled in a Medicare Advantage plan will continue to pay the Medicare Part B premium — and Part A, if applicable — in addition to Humana’s monthly premium.
Some Humana Medicare Advantage plans may contribute toward the Medicare Part B premium.
When someone gets a prescription, they must pay either a fixed copay amount or coinsurance, which is a percentage of the cost.
Plans have a yearly cap on what someone needs to pay for their medication.
People with a Medicare Advantage plan must pay a deductible, which is the amount that is due before Humana contribute toward the costs.
Some plans have a $0 deductible.
An example of 2021 costs for someone living in New York City, NY, and opting for the Humana Choice PPO plan — which includes drug coverage — are as follows:
- $0 monthly premium plus the $148.50 Part B premium
- $0 health deductible
- $350 drug deductible
- $0 physician and $0 specialist copay
- $2 preferred generic drug copay
The table below compares some costs for the options:
|Humana Walmart Value Rx Plan||Humana Premier Rx Plan||Humana Basic Rx Plan|
|Annual prescription deductible||$0 for tiers 1 and 2|
$445 for tiers 3, 4, and 5
|$0 for tiers 1 and 2|
$445 for tiers 3, 4, and 5
($305 in Puerto Rico)
|$445 on all tiers|
|Number of covered prescription drugs||more than 3,500||more than 3,700||more than 3,450|
Plans may stipulate that a person uses specific pharmacies or pharmacy networks. People may also have options for mail-order pharmacies.
Part D plans, including those bundled with a Medicare Advantage plan, have a coverage gap, or donut hole. After Medicare and the individual spend a certain amount on drug costs, the person will enter a temporary coverage gap.
The amount in 2021 is $4,130.00.
Since 2011, the donut hole has been gradually closing. When someone reaches the coverage gap, they pay a maximum of 25% of their prescription costs, plus the dispensing fee.
In 2021, if someone spends $6,550 while in the coverage gap, they will move to catastrophic coverage and pay only a small coinsurance or copay for their medications.
People must meet specific criteria to enroll in a Humana Medicare Advantage or standalone Part D plan.
In general, a person must be 65 years of age or older, though younger people can enroll if they:
- have had Social Security Disability Insurance for longer than 24 months
- have a specific health condition, such as end stage renal disease or amyotrophic lateral sclerosis
- may become eligible through family relationships
People can check their eligibility to join a Part D plan by using the Medicare Eligibility & Premium Calculator.
Humana offer both standalone Medicare Part D plans for prescription drug coverage and Medicare Advantage plans that include drug coverage.
If a person enrolls in original Medicare, they can extend their Part A and Part B health coverage with a standalone Part D drug plan.
Prescription drug plans use a tier system to price their medications. People should check a plan’s formulary to ensure that it includes their necessary medications.