Updated May 5, 2020
Waiving Medicare Advantage member out-of-pocket costs for in-network primary care, outpatient behavioral health and telehealth visits
When is this new benefit effective?
Effective May 1, 2020, Humana is waiving Medicare Advantage member out-of-pocket costs—copays, coinsurance and deductibles—for in-network primary care, behavioral health (on an outpatient, non-facility basis) and telehealth visits through the end of 2020.
Why is Humana taking these additional steps?
Humana’s goal is to make the healthcare experience better, more personal and more caring so that people can achieve their best health. Waiving member out-of-pocket costs for in-network primary care, outpatient behavioral health visits and telehealth visits gives members flexibility to seek and receive care in the best way for them and according to their physician’s recommendations.
We also hope the safety kits will contribute to our members’ safety, and the safety of others, as our members access the healthcare system or other essential services in the community.
What is the effective date of the expanded out-of-pocket cost waiver?
May 1, 2020.
Why waive out-of-pocket costs only for Medicare Advantage members? Why not all medical members?
Humana is focused on Medicare Advantage plans, the majority of the population of which are seniors, because these members are widely acknowledged to be among the most vulnerable of all populations.
Additionally, for our fully insured commercial customers, flexibility to change coverage terms is limited by applicable state and federal ERISA regulations. For self-funded commercial customers, Humana is required to act in accordance with employer coverage specifications. We have, and will continue to partner with employers to find compliant ways to enhance affordability, access and support.
For our Medicaid plans, states determine benefit levels and copays for Medicaid.
Specifically, which Humana insurance plan types does this apply to? Does this apply to Medicare Part D prescription drug plan members? Group Medicare members? Medicare Supplement members?
Humana is waiving primary care copays, coinsurance and deductibles for all in-network primary care, outpatient behavioral health and telehealth visits for the rest of 2020 for our individual and group Medicare Advantage members.
The waiver of members’ out-of-pocket costs for in-network telehealth services for the rest of 2020 also applies to commercial employer-sponsored plans. Self-insured plan sponsors will be able to opt out of the program at their discretion. Commercial members who seek care from out-of-network providers run the risk of balance billing (having to pay the difference between in-network and out-of-network charge), even with the waiver. We encourage commercial members to use participating providers to avoid any cost sharing.
Out-of-pocket cost waivers for in-network primary care, outpatient behavioral health and telehealth visits do not apply to Medicare Part D prescription drug plan members or Medicare Supplement plan members.
Which forms of cost sharing are included?
Humana is waiving copays, coinsurance and deductibles (all member out-of-pocket cost responsibility) for in-network primary care, outpatient behavioral health and telehealth service with in-network providers.
Does the waiving of primary care, behavioral health and telehealth cost sharing require a COVID 19 diagnosis?
No. Humana will be waiving Medicare Advantage member copays, coinsurance and deductibles for all in-network primary care, outpatient behavioral health and telehealth visits, regardless of diagnosis.
Does the copay waiver apply only to in-network providers?
Yes. Primary care, behavioral health and telehealth providers must be in network.
How do you define primary care? Are in-home visits included? Is urgent care included?
Primary care is basic or general healthcare usually rendered by general practitioners, family practitioners, internists, pediatricians and sometimes obstetricians/gynecologists—who are often referred to as primary care physicians or PCPs. The cost share will be waived if the services are delivered through office, clinic, telehealth or in-home visits. Cost share will not be waived for services provided in urgent care centers.
Are laboratory services and other services performed at the time of the primary care visit included in the waiver?
Humana will waive the member cost share for laboratory services performed in the physician’s office as part of the office visit. The cost share waiver does not apply to:
- Laboratory services that the physician orders and sends to an outside lab provider (Note: COVID-19 testing is still covered at no out-of-pocket cost)
- Radiology services such as mammograms
- Medicare Part B medications administered in the office
- Supplies received from the physician in the office
Where should I go to find a provider in my network?
Humana has made it easy to find a doctor that is covered by your healthcare plan. You can find a doctor by location, provider type, name or language. Simply use the online Find a doctor tool on Humana.com. If you do not have access to the tool, you can call the Customer Care number on the back of your Humana member ID card.
What if my PCP is not currently seeing patients? Will Humana be able to expand the network to make sure that I can see a provider to get care?
If your PCP is not currently seeing patients, there are two options that can help ensure you can access primary care. First, you can access one of our telehealth primary care providers. Second, you can call the toll-free Customer Care number on the back of your Humana member ID card for assistance in choosing a new primary care physician.
Why aren’t specialists included in the out-of-pocket cost waiver for primary care and behavioral health?
Humana is taking this action to ensure that Medicare Advantage members have access to the primary care they need to maintain their health, which is especially important for those with serious chronic conditions. The hallmark of primary care is its ability to broadly diagnose, treat and prevent a wide variety of conditions.
Note that specialists are included in the waiver of out-of-pocket costs for telehealth visits.
Why include behavioral health?
By including behavioral health, we aim to take a holistic approach to managing the very personal needs of our members. Proactive management of behavioral health conditions like depression or anxiety is important, especially at this time. With the strain of the pandemic and the social isolation that many are experiencing, we know that many of the most vulnerable in society are experiencing a worsening of their conditions or new symptoms. We want to do our part to facilitate access to behavioral health treatment. Moreover, there is clear evidence that untreated behavioral health conditions lead to worse management of other chronic conditions and adverse health outcomes.
Specifically what behavioral health services are covered by the waiver?
Humana is waiving all out-of-pocket costs for Medicare Advantage members who visit in-network behavioral health providers on an outpatient, non-facility basis. Eligible visits include individual therapy, psychiatric medication consultations and group therapy on an outpatient, non-facility basis.
Are you encouraging your members to visit their doctor in person? Is telehealth a safer option?
We are encouraging members to continue to seek preventive care and are concerned about the health implications of deferring care, particularly for those with chronic conditions. With that in mind, we are waiving out-of-pocket costs for both telehealth and in-person primary care and behavioral health visits so providers and their patients can determine the best care setting.
What is Humana doing to expand telehealth services during the COVID-19 pandemic?
Humana has extended telehealth cost-share waivers for all telehealth visits, including those with in network primary care physicians and specialists, including behavioral health, through the end of the 2020 calendar year.
To encourage members to seek care safely while protecting the healthcare workforce, Humana is waiving member cost share for all telehealth services delivered by in-network providers, including telehealth services delivered through MDLIVE® to Medicare Advantage members and to commercial members in Puerto Rico, as well as all telehealth services delivered through Doctor On Demand® to commercial members. Both in-network primary care and specialty providers can deliver care using telehealth services, provided that the Centers for Medicare & Medicaid Services (CMS) and state-specific guidelines are followed. This includes behavioral health services. For telehealth visits with a specialist, members are encouraged to work with their primary care physician to facilitate care coordination.
Members can call the toll-free Customer Care number on the back of their Humana member ID card to get support with specific coronavirus questions and concerns, including live assistance with telehealth.
Will premiums rise next year in light of these actions?
These actions will not impact 2021 premiums.
How do these actions align around any reopening guidance provided by federal, state and local authorities?
Humana’s actions are not connected to any specific reopening guidance. Instead, these policies are intended to support member access to care through whatever channel they and their provider determine is best.
Notifying Members and Providers
How will my doctor or healthcare provider know that you are taking these actions?
Humana works in close partnership with doctors and healthcare providers. We have notified all our network providers of the actions we are taking through email and also through updated messaging on our Provider COVID website.
How will members be notified of the changes?
We will be sending a letter to all our Medicare Advantage members regarding the changes in benefits. We also have reminder messaging for members on Humana.com and in the MyHumana app.
Why does the website or Humana app say that I have a copay when you’ve waived them?
We have only waived Medicare Advantage member out-of-pocket costs for primary care, behavioral health and telehealth. You will still have copays, or other forms of cost sharing, for specialist care, emergency room (ER), urgent care and hospitalizations, to name a few. Since Humana is waiving out-of-pocket costs, your formal benefit design will not change, and as a result, your primary care copay will still show the original amount. We are adding messaging to our Humana.com site to remind members of the waiver and to avoid confusion when they view their benefit design on Humana.com.
What happens if my doctor tries to charge me for a copay when I go to the office or at the start of the telehealth visit?
It’s possible your doctor’s office forgot about the message as they typically see members from many different health plans. You can show your doctor the letter and the sticker you placed on your member ID card as a reminder. You can also ask your doctor to call Humana’s provider relations phone number or member Customer Care to confirm. (These numbers are on the back of your Humana member ID card.) And remember that this out-of-pocket cost waiver is in effect as of May 1, 2020, so if you went to the doctor before then, the requested copay does apply.
I just got a bill OR my physician’s office charged my card on file for the copay after the visit. What should I do?
If, after your visit, your doctor’s office sent you a bill or charged your credit card for a copay or coinsurance for a primary care visit, behavioral health visit or a telehealth visit, we will need to contact your doctor’s office to get this resolved. You can call your doctor directly or we can assist you with making this call. If you would like assistance, you may contact the Humana Customer Care number on the back of your Humana member ID card.
Waiving medical costs related to coronavirus testing and treatment
Is Humana still waiving all member costs for treatment related to COVID-19?
Yes. Humana is waiving member cost sharing for COVID-19 treatment and testing for the following:
- Humana Medicare Advantage members
- Humana Medicare Supplement members*
- Humana fully-insured group commercial members
- Humana Medicaid members
- Humana employee health plan members
*Note that Humana will only cover the cost share for the coverage provided: e.g., medical cost only for Medicare Supplement.
Member copays, deductibles and coinsurance cost sharing will be waived for covered services for COVID-19 related tests and treatments regardless of where they take place. This could include telehealth, primary care physician visits, specialty physician visits, facility visits, labs, home health and ambulance services.
We also intend to cover the cost of FDA-approved vaccines and medications when they become available for members for whom we provide prescription drug coverage.
Why aren’t all plans eligible?
Not all member plans are eligible. This does not apply to TRICARE members and our commercial self funded ASO clients. We are working in close partnership with the Defense Health Agency (DHA) to determine how best to support TRICARE beneficiaries.
Self-funded ASO clients bear the financial risk for coverage decisions, and we are not able to make coverage policy changes without their approval. We are reaching out to these clients to confirm whether they will follow our approach. If you are unsure if you fall into this category, you should confirm your employer-sponsored coverage type with your employer.
This does not apply to Part D-only plan members. Part D-only plan members continue to be eligible for prescription benefits.
Are these expanded benefits the same from state to state?
Unless specifically noted, all of the information on this page applies to Humana members nationwide. However, in the event that individual states find themselves facing unique challenges, Humana will work closely with them to help support our members there. To see the latest information specific to your state, click here.
Does this require a confirmed coronavirus diagnosis?
No. We will waive member costs for testing and treatment claims for suspected or confirmed COVID-19 cases.
When is this effective? Is it retroactive for members who might have already paid cost sharing, etc.?
This coverage decision is retroactive to February 4, 2020.
When does this end?
There is no current end date; we will reassess as circumstances change.
Will these costs be included in or apply to the member’s maximum out-of-pocket (MOOP)?
Only a member’s cost share is applied to the maximum out-of-pocket calculation. Since the member cost share for COVID-19-related treatment is being waived, nothing will be applied to MOOP.
Does this impact in- and out-of-network claims?
Humana encourages members to continue to see or consult with the healthcare provider they already know. We will cover the member responsibility for member copays, deductibles or coinsurance costs for COVID-19-related services for in-network or out-of-network covered benefits during this time of crisis.
We will also continue to reimburse providers as we do today, consistent with existing contractual arrangements and according to plan benefits, in compliance with state and federal rules. For out-of-network providers, it’s important to note that we may not be able to insulate our commercial insured members from unexpected balance billing. Therefore, we encourage the use of in-network providers.
Prescription and Vaccine Coverage
Regarding COVID-19 treatment, what medications will Humana cover? Will Humana cover Remdesivir?
Humana intends to cover the medical cost of treatment and FDA-approved vaccines and medications when they become available. If a member is prescribed non-FDA-approved medications for the treatment of COVID-19, he or she will be responsible for any cost sharing required per the plan design. Non-FDA approved drugs are excluded Part D drugs and ineligible for any Part D coverage.
NOTE: As of May 3, 2020, the FDA has not approved Remdesivir for the treatment of COVID-19.
Are any of the existing medications that could help treat COVID-19 covered (e.g., anti-RA drugs, HIV/malaria drugs)?
We intend to cover member responsibility for medical cost of treatment and FDA-approved vaccines and medications when they become available. Currently, there are no FDA-approved vaccines or medications for the treatment of COVID-19.
What does the FDA’s Emergency Use Authorization for hydroxychloroquine mean?
The FDA’s Emergency Use Authorization of hydroxychloroquine and chloroquine means that, while these drugs are still not FDA approved for the treatment of COVID-19, hospitals may request access to these medications to treat adults and adolescents who are hospitalized for COVID-19.
How can I ensure access to my prescription medications while practicing social distancing or sheltering in place?
Humana suggests its prescription drug plan members access their prescriptions using mail-delivery pharmacies. Please refer to the pharmacy directory for your Humana prescription drug plan to find a list of network mail-order pharmacies. Some network retail pharmacies may also offer home delivery during this public health emergency. Humana Pharmacy is a mail-order delivery pharmacy and many Humana plans offer preferred cost sharing for most Tier 1 and Tier 2 generics through Humana Pharmacy. Members can register for mail order delivery from Humana Pharmacy at , opens new window or by calling 1-800-379-0092. Other pharmacies are available in the network.
Will Humana waive refill limits to ensure I have access to my regular medications?
Yes. Humana is allowing early refills through July 25, 2020, on prescription medicines so members can prepare for extended supply needs—an extra 30- or 90-day supply, as appropriate. For specialty tier medications, we are waiving early refill limits for a 30-day supply.
What if I need early prescription refills after July 25, 2020?
AHumana will continue to evaluate that end date by monitoring the situation, listening to your feedback and exploring ways we can support your health.
I’m concerned about shortages. Will Humana Pharmacy have my medication and be able to fill and ship my medication to me?
Humana is continually monitoring the drug supply chain. Humana Pharmacy is currently working with drug manufacturers and the FDA to ensure members do not experience unnecessary disruptions that would affect their ability to fill prescription medications.
Can I get a vaccine and will Humana cover it?
At present, there are no commercially available vaccines for COVID-19. However, if one were to become available, Humana would cover that vaccine for its members.
Who is going to be receiving safety kits from Humana? What if my family members, who are not Humana members, need a safety mask? Can I get a safety kit for them too?
We are providing safety kits to all medically insured members: approximately 6.4 million people. This includes members on Humana individual and group Medicare Advantage, Medicare supplement, Medicaid and commercial employer-based health plans. We are currently only able to supply our members with this safety kit. We’d like to offer an unlimited number of masks, but this would be logistically difficult given Humana’s large membership base, which is in the millions. The Centers for Disease Control and Prevention’s (CDC) directions for making your own mask can be found , opens new window
What exactly will the safety kit include?
The safety kit contains two washable face masks, as well as health advice and information about how Humana can support our members as they seek care.
When should I expect to receive my safety kit?
Safety kits will be sent to members’ homes starting in late May and throughout the summer.
How can I get more safety kits?
We currently do not have additional supply. We will be monitoring the situation with our members to determine how we can continue to support them during this difficult time. The CDC’s directions for making your own mask can be found , opens new window
How long do the masks last? Can they be washed? If so, how many times? Can I receive additional masks if needed?
The masks can be washed 30 times. We currently do not have additional supply and will be monitoring the situation with our members to determine how we can continue to support them during this difficult time. The CDC’s directions for making your own mask can be found , opens new window
Personal protective equipment (PPE) is in short supply. How has Humana been able to secure the necessary amount of masks?
Humana has worked diligently to build a safe and secure supply chain since before the COVID-19 crisis, so we can be flexible to support both our caregivers and members.
NOTE: The masks distributed to members are not the N95 quality that healthcare workers are using but rather appropriate masks for use in public settings (going to the doctor, grocery store, etc.). The CDC’s directions for making your own mask can be found , opens new window
How can I get help with food and groceries, prescription refills and routine medical issues to try to avoid a trip to the doctor or ER?
Humana is working to ensure members in need have access to basic necessities—including food, medication, and access to care. Humana is providing resources to members and connecting them with community organizations in their local areas. Members who are having difficulty obtaining these necessities can call the number on the back of their Humana member ID card for support. They can also take a quick coronavirus assessment or find out about resources available to them at humana.com/coronavirus.
What other policy changes related to COVID-19 has Humana previously announced?
Humana previously announced that it is:
- Waiving the out-of-pocket costs (copays, coinsurance and deductibles) associated with COVID-19 treatment and testing
- Allowing early prescription refills, so members can prepare for extended supply needs—an extra 30- or 90-day supply as appropriate
- Providing a member-support line with specially trained call center employees to help support members with specific coronavirus questions and concerns, including live assistance with telehealth
- Taking actions designed to help provide financial and administrative relief for the healthcare provider community facing unprecedented strain during the coronavirus pandemic
- And, the Humana Foundation has committed $50 million to coronavirus relief and recovery efforts.
Who should NOT wear a mask?
According to the CDC, Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
Should I cancel my in-home care appointments because of COVID-19?
No. Your care is important, and it’s vital to maintain coordination with your healthcare providers. If you have a history of recent travel and symptoms like fever, cough or shortness of breath, please consult your healthcare provider. Call ahead before you request a home visit and tell the representative about your symptoms and any recent travel.
What steps is Humana taking to ensure my safety when a nurse practitioner visits my home?
Supporting our members through this time of uncertainty is important to us. We’re following the most up-to-date advice from the CDC—on hand-washing, disinfection, protective garb and other safety precautions—to keep you healthy.
What is Humana’s Human Care?
Human Care is what Humana does and provides to make the healthcare experience easier, more personalized and more caring. It is the actions Humana takes and the services that we provide to help make the healthcare experience better for our members. We seek to go above and beyond to make the experience “more human” to deliver what matters most to our members.