Humana Offers Suite of Medicare Products

Humana’s Medicare suite of products includes PFFS, PPO, HMO* and Medicare supplement plans. The chart below outlines the variety of choices Humana offers within each product line. In broad terms, here are some of the key differences between the product lines:

• Medicare Advantage Health Maintenance Organization (HMO) members must choose primary care physicians from the Humana network. The Medicare Advantage HMO product name is Humana Gold Plus. *This product is only available in the following markets: Jacksonville, Orlando, Daytona, Tampa, South Florida, Chicago, Kansas City, Corpus Christi, San Antonio, New Orleans, Shreveport, Baton Rouge, Phoenix and Puerto Rico.
• Medicare Advantage Preferred Provider Organization (PPO) members enjoy in-network advantages, such as lower out-of-pocket costs along with out-of-network freedom to choose any provider in the Medicare program. The Medicare Advantage PPO product name is HumanaChoicePPO. The PPO plans may operate on a local or regional basis, or both, depending on the geographic area approved by the Centers for Medicare & Medicaid Services (CMS). A local PPO is based in one city or in several counties surrounding one city; a regional PPO covers an entire state or several states. In areas that are covered by both a local and a regional PPO, physicians participate in both networks, but member benefits vary between the local and the regional plans. Physicians’ offices should check member ID cards for copayment information.
• Medicare Advantage Private Fee-for-Service (PFFS) members have the freedom to choose their own doctors, specialists and hospitals. The Humana Medicare Advantage PFFS product name is Humana Gold Choice. Members may see any health care provider who is Medicare-certified and agrees to Humana’s payment terms and conditions.
• Medicare Supplement members have chosen to purchase additional coverage as a supplement to Original Medicare. This relationship is transparent to the physician’s office: the physician bills Medicare for all services provided to the member, and Medicare forwards the claims to Humana.

While physicians may contract for participation only in specific product lines, Humana encourages physicians to accept members of any Humana Medicare Advantage plan offered in their market. The suite of products is designed to serve the varying needs of different segments of the Medicare population. Participating with all of Humana’s Medicare Advantage plans makes physicians’ practices open to a wider range of Medicare beneficiaries in the community. Physicians who wish to change the level of their participation in Humana’s Medicare network should contact their local contracting representative (see chart below for more information).

Back to top