Humana's Your Practice

Humana Medicare Advantage
Plans to Be Available in Most States

Humana will expand the geographic reach of its Medicare Advantage plans, which include prescription drug coverage, to 46 states starting January 1, 2006. Humana will also offer regional preferred provider organization (PPO) plans to Medicare-eligible beneficiaries in 23 states and private fee-for-service (PFFS) Medicare plans in more than 30 states in 2006.

Humana Medicare Advantage plans, which also include HMO options in many regions, are alternatives to Original and supplemental Medicare insurance. The plans are designed to offer affordable health insurance coverage to Medicare-eligible people throughout a geographic region. All plans feature:

low copayments to see physicians
coverage for generic and brand-name medications
preventive services, including annual physical examinations
affordable monthly premiums
out-of-pocket expense limits

In many states, Medicare beneficiaries will also be able to choose a Humana Medicare Advantage HMO plan that offers no or low monthly plan premiums, depending on the package of benefits selected.

Humana’s PFFS and PPO Medicare Advantage plans do not require participants to select primary care physicians or obtain referrals before seeing specialists. In addition, several of the Medicare Advantage plans provide worldwide coverage for emergency and urgent care.

Humana’s Gold Choice PFFS plan also does not require beneficiaries to choose physicians from a regional network of providers.

Although HumanaChoicePPO plans do have provider networks, beneficiaries in these plans may select physicians, specialists or hospitals outside of their plan’s regional network without referral. However, members may be required to pay more for certain nonurgent, nonemergency services outside of their PPO plan network.

Physicians who accept Medicare, but do not participate in a Humana Medicare PPO network can still treat Humana Medicare PPO members at the nonparticipating provider rate. The advantages for physicians to participate in a PPO network include:

control of new-patient enrollment
no referrals are required; prior authorization is required for certain services
time-of-service copayments from patients and direct reimbursement from Humana for the physician’s remaining charges up to Humana’s Medicare PPO allowable amount

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

Humana Medicare Advantage Plans Plans in many regions feature the SilverSneakers^® Fitness program, a program created to encourage older adults to become and stay more active. The plans also offer all of the benefits of Original Medicare: prescription drug coverage and discounts, low copayments for office visits and other services, predictable out-of-pocket costs for most services and routine physical exams.
Plan Name	Additional Monthly Plan Premiums*	Provider Choice	Benefit Highlights++	Features
Original Medicare	$0	Choose any health care provider that accepts Medicare.	Covers medically necessary hospitalization and office visits.	Limited coverage for hospitalization, physician services and other medical care. No network restrictions.
Humana HMOs	$0-varies by region	Choose from a network of health care providers. Requires selection of primary care physician and authorization for referrals and services.	Original Medicare benefits plus prescriptions, vision, hearing, dental, emergency travel coverage and preventive care.	Easily budgeted expenses, more coverage, provides value at a low cost.
Humana Choice PPO	$0-varies by region	Choose from a preferred network of physicians and specialists without referrals. Members pay higher cost-share for out-of-network providers. Referrals are not required, but prior authorization is required for certain services.	No requirement to select a PCP or get specialist referrals. Includes prescriptions, vision, hearing, dental, hospitalization, preventive care and substantial coverage when traveling.	No referrals and greater freedom of choice in provider selection. Generally lower premium cost than a Medicare supplement, but higher than an HMO.
Humana Gold Choice PFFS	$0-various by region	Choose from any health care provider that accepts Medicare and Humana’s terms and conditions of payment. Referrals are not required.	Original Medicare coverage plus preventive services, prescription drug coverage and some routine services.	No provider network means greater freedom of choice and no referrals. Offers value and low cost compared to a Medicare supplement.