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Question: Is Medicare and Humana the same thing? Do they both have the same benefits? Does Humana pay more for medication than Medicare? Please explain.

Answer: First, yes, the Medicare Part D program does get a little confusing.

Medicare is the government program started in 1965 by President  Johnson to provide health care for seniors citizens (over 65) and people receiving disability benefits.

Today, Medicare is operated by the Centers for Medicare and Medicaid Services (CMS) under the US Department of Health and Human Services (HHS).  Medicare includes the complete social insurance program and is usually divided into Medicare Part A (in-patient or hospitalization insurance), Medicare Part B (out-patient and doctor visits), Medicare Part C (Medicare Advantage plans), and Medicare Part D (prescription drug plans).

Medicare does not directly implement these last two programs (Medicare Part C and Medicare Part D) and instead contracts with private firms or insurance carriers for the purposes of implementation.

Please note that private firms implement Medicare Part C Medicare Advantage plans and Medicare Part D prescription drug plans under the guidance and regulations established by CMS.

Humana is one of the large private insurance companies that provides, along with other products, Medicare Advantage plans and Medicare Part D prescription drug plans.  Therefore, Humana is contracted with the federal government to provide and administer these plans under the Medicare program.  To learn more about Humana, you can visit their website at www.Humana.com.

Some limited prescription medication is covered directly under Medicare Part A and Medicare Part B, but the Medicare Part D program was really designed to provide self-administered, out-patient prescription drug coverage for seniors and other Medicare beneficiaries.  So there probably will not be a situation where both Medicare and a private company would both cover the same medication, allowing you to choose the program that offers a lower price on the medications.

(Please note:  If you have VA benefits, and you have prescriptions that are available from both the VA and your Medicare Part D plan, you will be able to choose either your Medicare Part D plan or the VA as the source for some of your medications, depending on the cost.)

Since not all prescriptions drugs are covered by a Medicare Part D plan and you will need to refer to the current Medicare Part D formulary or drug list for an overview of the covered medications and the cost-sharing for the covered medications.  You can review any Medicare prescription drug plan formulary at: www.FormularyBrowser.com (here is a link is going to an example of the 2014 Humana-Walmart Medicare Part D plan formulary available in Florida).

In summary, if you have a Humana Medicare Part D prescription drug plan then you will have some or all of your covered out-patient prescription medication costs covered by the plan.  However, a Medicare Part D plan can change the cost you will pay for a covered prescription drug from year-to-year and you will need to review the details of the current Medicare plan to see the costs of drug coverage.

A portion of your medication cost coverage is paid by Medicare and a portion is paid by Humana (for instance, in the Catastrophic Coverage portion of your Medicare Part D plan, the federal government pays for your medication costs).  In addition, a portion of your covered brand-name prescription costs while in the Donut Hole or Coverage Gap are paid by the pharmaceutical manufactures.




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