Humana offer vision coverage with some of their Medicare Advantage (Part C) plans. If someone does not have vision coverage with their Humana plan, they can buy an add-on.
People who qualify for original Medicare can enroll in a Humana Medicare Advantage plan and get additional vision coverage benefits, which may include annual exams, eyeglasses, and contact lenses.
This article explores Humana Medicare Advantage plans and their vision care coverage. It also looks at eligibility and costs.
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 who started as Extendicare, a nursing home company. The company expanded to hospitals and other health facilities and changed their name to Humana in 1974.
Humana have their headquarters in Louisville, KY, and they now operate in all 50 states, plus Washington, D.C., and Puerto Rico.
They administered Medicare Advantage plans for 4.5 million members across the country in 2019, and they are currently the fifth largest health insurance company in the United States.
Medicare Advantage plans offer healthcare coverage beyond that of original Medicare (Part A and Part B). Private insurance companies such as Humana offer these plans, which provide at least the same coverage as original Medicare. Usually, however, Medicare Advantage plans also offer dental, vision, hearing, and prescription drug coverage.
Medicare Advantage plans limit the annual out-of-pocket costs for Medicare-covered services, which may help a person avoid any unexpected expenses. However, any associated costs depend on the plan’s coverage level and location.
People who qualify for original Medicare can opt for a Medicare Advantage plan instead. This includes individuals aged 65 years and over, as well as younger people with certain physical disabilities or health conditions.
Types of Medicare Advantage plan
There are various types of Medicare Advantage plan, including the following:
- Health Maintenance Organization (HMO) plans use a network of providers.
- HMO Point-of-Service (HMO-POS) plans allow members to use out-of-network providers at a higher cost.
- Preferred Provider Organization (PPO) plans also have provider networks, but members need not nominate a primary care physician.
- Private Fee-for-Service (PFFS) plans charge a specified amount for services.
- Special Needs Plans (SNPs) support people with chronic health conditions or financial restraints.
People can use the online plan finder tool to check which Medicare Advantage plans are available in their location.
Humana Medicare Advantage plans provide original Medicare coverage, including:
- hospital inpatient stays
- doctor visits, including preventive care and shots
- diagnostics
- mental health services
- physical therapy
- durable medical equipment
- emergency and urgent care
- some transportation services
Humana offer a range of Medicare Advantage plans, including HMO plans, PPO plans, PFFS plans, and SNPs.
Humana HMO plans
When someone joins an HMO plan, such as the Humana Gold Plus, they must use a network of providers and choose a primary care physician. The primary care physician provides referrals to see specialists or other providers.
Humana also offer an HMO-POS plan, which allows members to use out-of-network providers at greater expense.
HMO plans are typically more affordable than other types of Medicare Advantage plan. Humana offer $0 monthly premium plans in some locations.
Humana HMO plans also cover emergency medical care outside of the U.S.
Humana PPO plans
With a Humana Choice PPO plan, an individual need not nominate a primary care physician or request referrals to see specialists. People can see any Medicare-approved doctor, but out-of-plan providers will usually cost more.
These plans also cover emergency care outside of the U.S. People may also add prescription drug coverage, vision, dental, and hearing coverage for additional premiums.
Humana PFFS plans
People who choose a Humana PFFS plan can see any Medicare-approved doctor who accepts Humana’s terms of service and conditions of payment. Humana determine what they pay healthcare providers and how much the plan member must pay for their care.
Members need not choose a primary care physician and do not require referrals to see a specialist.
Most PFFS plans include prescription drug coverage, and all of them cover emergency care outside of the U.S.
Humana SNPs
Humana SNPs usually do not have copays, premiums, or coinsurance.
A person will qualify for Humana SNPs if they have a chronic disabling condition or are eligible for both Medicare and Medicaid.
When someone qualifies for a Humana SNP, they benefit from the same coverage level as original Medicare, plus prescription drug coverage.
Humana Medicare Advantage plans include some vision services.
Because Medicare Advantage plans offer the same basic coverage as original Medicare, Humana plans offer coverage for medically necessary vision treatments that maintain optical health. This may include surgery to remove cataracts or after an eye injury.
Medicare Part B contributes 80% of the cost of one pair of eyeglasses or set of contact lenses after cataract surgery after a person has reached the Part B deductible. Medicare Part B also covers an annual eye exam for diabetic retinopathy.
Some Humana Medicare Advantage plans include vision care such as eye exams, and additional available benefits include discounted eye exams and a yearly allowance for eyeglasses or contact lenses.
Humana Medicare Advantage plans have associated costs, including:
- Monthly premium: People continue to pay the Medicare Part B premium, and they also pay a monthly premium to Humana.
- Copays and coinsurance: When someone receives care, they pay either a fixed copay or coinsurance, which is a percentage.
- Deductible: Plan members must pay this amount before Humana will cover any costs.
For example, for someone living in Los Angeles, CA, the Humana Gold Plus HMO costs for 2021 are:
- $0 monthly premium
- $0 deductible
- $0 physician and $0 specialist copay
People can find more costs and plan details by entering their zip code on the Humana Medicare Advantage website.
People who qualify for original Medicare (parts A and B) are eligible to enroll in a Humana Medicare Advantage plan.
Most people qualify for original Medicare at age 65 years. However, others may qualify at different times, depending on whether or not they receive Social Security or Railroad Retirement Board disability pensions.
If someone has a diagnosis of end stage renal disease or amyotrophic lateral sclerosis, they may also qualify for Medicare at a different time.
Humana Medicare Advantage plans offer benefits beyond original Medicare, including vision, hearing, dental care, and limited out-of-pocket expenses.
People who qualify for Medicare are eligible to enroll in a Humana Medicare Advantage plan.