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.
2015 PDP-Finder - Medicare Part D Plan Finder The 2015 PDP-Finder displays Medicare Part D plan information, including plan premium, deductible, type of gap coverage and if the plan qualifies for the $0 premium for those persons with a low income subsidy (LIS).
The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
Medicare has neither reviewed nor endorsed the information on our site.
We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information.
However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist.
For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area.
However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service
area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048),
24 hours a day/7 days a week or consult www.medicare.gov.
When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare.
Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits
money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible.
The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll
during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the
Beneficiaries can appoint a representative by submitting CMS Form-1696.