Humana Introduces Suite of Medicare Products

This year, Humana began offering a complete suite of Medicare Advantage products. Medicare-eligible members who are covered by Medicare Part A and Part B can now choose between the Humana Medicare Advantage products available in their area as alternatives to Original Medicare coverage and supplements.

All of Humana’s Medicare Advantage plans include worldwide coverage for emergency and urgent care, as well as limits on out-of-pocket expenses. Most plans also include prescription drug benefits.

The two newest additions to Humana’s Medicare Advantage offerings include Humana Choice PPO and Humana Gold Choice, a private fee-for-service plan. Humana’s Medicare PPO and private fee-for-service plans offer other attractive features, such as:

• Low or no copayments to see physicians
• Coverage for generic and brand-name medications
• Routine annual physical examinations
• Lifestyle and health management guidance
• No requirement to select a primary care physician
• No referrals needed to visit a specialist

Humana Gold Choice is not a network-based plan, so providers do not have to be contracted with Humana to treat members enrolled in this plan. Humana Gold Choice reimburses providers based on Original Medicare reimbursement methodologies and follows all Medicare policies and guidelines. Referrals and authorizations are not required, and members can see any provider who is Medicare-certified and agrees to Humana’s terms and conditions.

Select markets offer Medicare Advantage HMO plans, and Humana also offers a Medicare supplement plan. A stand-alone prescription drug plan will be introduced in 2006.

Physicians who accept Medicare but do not participate in Humana’s Medicare PPO network can still treat Humana Medicare PPO members at a nonparticipating provider rate. However, there are many advantages for physicians who participate in the Humana Medicare PPO network, including:

• Referrals and authorizations are not required for most services.
• Physicians can control new member enrollment.
• Physicians do not have to file a separate claim as required with a Medicare supplement plan.
• Physicians receive a copayment at the time of service for most services and are reimbursed directly by Humana for the remaining amount up to Humana’s Medicare PPO allowable.

For more information about Humana Choice PPO, contact Humana’s Provider Relations at (800) 626-2741. For more information about Humana Gold Choice, call (866) 291-9714.