Is a Medicare Advantage Prescription Drug Plan from Humana the Same as a Standalone Medicare Prescription Drug Plan from Humana?

Mike Olmos by Mike Olmos | Licensed since 2010
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This article was updated on: 10/21/2018

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Understanding your coverage under the Medicare program is an important first step in understanding the benefits available through Medicare Prescription Drug Plans and Medicare Advantage plans from Humana. The Medicare program is divided into four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

Original Medicare is made up of Part A and Part B. Medicare Part C offers another way to get your Part A and Part B benefits. Medicare Advantage plans must, at a minimum, cover everything that Original Medicare covers (except for hospice care, which is still provided under Part A). In many cases, these plans also include Part D prescription drug coverage (also known as Medicare Advantage Prescription Drug plans). In addition, Medicare Advantage plans may offer other benefits such as routine vision and dental care and/or wellness program coverage.

If you choose to stay enrolled in Original Medicare, prescription drug benefits are available through a stand-alone Medicare Prescription Drug Plan that works with your Original Medicare coverage.

Here’s an overview of the Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans offered by Humana.

What types of Medicare Advantage plans from Humana include prescription drug coverage?

Humana currently offers three different types of Medicare Advantage plans:

  • Humana Gold Plus Health Maintenance Organization (HMO) plans
  • Humana Choice Preferred Provider Organization (PPO) plans*
  • Humana Gold Choice Private Fee-for-Service (PFFS) plans

Humana’s Medicare Advantage plans often include prescription drug coverage. The plans use a formulary, or list of covered medications, to determine prescription drug benefits; if you currently take prescription drugs, you should always check the formulary before enrolling in a Medicare plan that offers prescription drug coverage to make sure your medications are included. Keep in mind that your plan may change its formulary at any time, but it must notify you in writing if it does.

Because these Medicare Advantage plans from Humana may include prescription drug coverage, you generally cannot combine them with a stand-alone Medicare Part D Prescription Drug Plan. In fact, if you enroll in a stand-alone Medicare Part D Prescription Drug Plan while you’re covered by a Medicare Advantage plan that includes prescription drug benefits, you’ll be automatically removed from your Medicare Advantage plan and returned to Original Medicare.

Please keep in mind that every plan may not be available in every area, and plan benefits and premiums may vary by location. Other things to keep in mind about Humana’s Medicare Advantage plans:

  • You must continue to pay your Part B premium while you are enrolled in a Medicare Advantage plan (from Humana or any Medicare-approved insurance company).
  • There may be an additional monthly premium, depending on the plan you choose. If your Medicare Advantage plan includes prescription drug benefits, the premium may reflect both the cost of your Part C and Part D coverage.

What’s included in a Medicare Part D Prescription Drug Plan from Humana?

Humana is a private insurance company contracted with Medicare to provide prescription drug coverage under the Medicare Part D program. As such, it is required to offer a minimum standard of benefits required under the Medicare program. Medicare Prescription Drug Plans are designed to complement your coverage under Original Medicare and, as mentioned, cannot be combined with Medicare Advantage plans that include prescription drug coverage.

Like Medicare Advantage Prescription Drug plans, Humana’s Medicare Part D Prescription Drug Plans also use formularies to determine your benefits; some may also require you to use participating network pharmacies. You may also be offered a tiered formulary option, in which lower-tiered or generic medications may be available at lower copayments, while higher-tiered medications may have higher copayments.

As with Humana’s Medicare Advantage plans, not every stand-alone Medicare Part D Prescription Drug Plan offered by Humana may be available in every location, and plan benefits may vary depending on where you live. You will pay a separate monthly premium for your prescription drug coverage in addition to your Part B premium, and your premium may vary by location.

Do you need help finding Medicare plan options that cover your specific prescription drugs? You have a few options to do so:

  • To find coverage from Humana that fits your prescription drug needs, visit the Humana page to get started.
  • If you’re ready to compare plan options right away, you can use the Find Plans button on this page to start browsing in your area.

 

*Humana is a Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. [Benefits, premiums and/or member cost-share] may change on January 1 of each year.

**The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.

Humana’s pharmacy network offers limited access to pharmacies with preferred cost sharing in urban areas of <AL, CA, CT, DC, DE, IA, IL, IN, KY, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NH, NJ, NY, OH, OR, PA, RI, SC, SD, TN, VA, VT, WA, WI, WV; suburban areas of AZ, CA, CT, DE, HI, IL, MA, MD, ME, MI, MN, MT, ND, NH, NJ, NY, OH, OR, PA, PR, RI, VT, WA, WV>; and rural areas of <AK, IA, MN, MT, ND, NE, SD, VT, WY>. There are an extremely limited number of preferred cost share pharmacies in urban areas in the following states: <DE, MA, MD, ME, MI, MN, MS, ND, NY, OH, SC, and VT>; suburban areas of: <MT and ND>; and rural areas of: <ND>. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, please call Customer Care at <1-800-281-6918 (TTY: 711)> or consult the online pharmacy directory at Humana.com.

***Out-of-network/non-contracted providers are under no obligation to treat <Plan/Part D Sponsor> members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

****Humana Inc. and its subsidiaries (“Humana”) do not discriminate on the basis of race, color, national origin, age, disability, or sex.

English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call [[Phone]] (TTY: 711).

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