Personal Care Account (PCA) Plan overview

Humana's Personal Care Account (PCA), also called a Health Reimbursement Arrangement, helps you manage your healthcare costs. A PCA is similar to an expense account that your employer puts money into. You can use the funds for qualified medical expenses like doctor's office visits, as well as other eligible healthcare costs. The PCA is usually combined with a Preferred Provider Organization (PPO) plan. With this plan, you may have a higher deductible — but PCA funds can be used to "pay down" your deductible.

 

Manage costs with this “expense account”

The PCA is like an expense account your employer puts money into. The amount of the PCA and list of eligible expenses varies by employer.

You can use your PCA for medical expenses like doctor's office visits, as well as other eligible healthcare costs. Check with your employer for a complete list. In addition to services your health plan covers, like doctor's office visits, categories of eligible expenses can include:
  • Dental services
  • Eye exams, eyeglasses, contact lenses and solution, and laser surgery
  • Orthodontia, dental cleanings, and fillings
  • Prescription drugs
  • Physical therapy, speech therapy, and chiropractic expenses

However, your company may not include all of the categories above. You can't use the money for experimental treatments, cosmetic procedures, or insurance premiums.

The PCA is usually combined with a Preferred Provider Organization (PPO) plan. With this plan, you may have a higher deductible — but PCA funds can be used to "pay down" your deductible. You can also use PCA funds for pharmacy expenses. If you use all of your PCA funds, you pay additional medical expenses until you meet your deductible for the year. Once you've met the deductible, you pay only the coinsurance percentage for covered services specified in your plan.

If you don't use all of your PCA funds during the plan year, you may be able to carry over some or all of your money to the next year, as long as you enroll in the same type of Humana plan with the same employer. Your employer determines whether you have this option, how much can be carried over, and when funds are available. See your Summary Plan Document for details.

As of Jan. 1, 2011, over-the-counter medications such as pain relievers, cough syrup, and allergy medicines require a prescription to be eligible for reimbursement from a Flexible Spending Account or PCA. The HumanaAccess Card will not be able to be used to purchase OTC medications.

Example of how it works — single coverage

Troy chooses a PCA PPO plan that includes:
  • $500 PCA
  • $2,000 deductible
His healthcare costs for the year involve a sore throat that just won't go away. Troy's healthcare costs for the year total $300:
  • Doctor’s office visit | $150
  • Lab tests | $100
  • Two prescription copayments | $50
How Troy uses his PCA for healthcare costs
  • PCA funds at the start of the year | $500
  • Cost of medical services (counts towards deductible) | $250
  • Cost of prescriptions (doesn't apply to deductible) | $50
  • Troy uses PCA to pay | $300
  • PCA funds remaining | $200
  • Deductible remaining | $1,750
Summary

Troy used his PCA to pay all of his healthcare costs for the year. The amounts associated with his health plan – the doctor's visit and lab tests – apply to his deductible.

Example of how it works — employee and child

Mia chooses a PCA PPO plan that includes:
  • $2,000 PCA
  • $3,000 deductible

Mia has one doctor's appointment during the year and has outpatient surgery on her foot. Her daughter, Melissa, gets an ear infection. She goes to the doctor and fills one prescription. Their healthcare costs for the year total $2,150.

  • Two doctor's office visits | $300
  • Outpatient surgery | $1,800
  • One prescription | $50
How Mia uses her PCA for healthcare costs
  • PCA funds at the start of the year| $2,000
  • Cost of medical services (counts toward deductible) | $2,100
  • Cost of prescriptions (doesn't apply to deductible) | $50
  • Mia uses PCA to pay | $2,000
  • PCA funds remaining | $0
  • Mia pays remaining deductible out of pocket | $150
Summary

Mia used her PCA to cover all but $150 of her medical and prescription drug costs for the year. The amounts associated with her health plan — the doctor's visits and outpatient surgery — apply to her deductible.

Please note that the situations described on this page are fictitious in nature, and are solely used for illustration of the plan.

 

Financial tools

Here are some Humana tools that may be useful to members who have a Personal Care Account.

Sample PCA qualified expenses

View a sample list of allowable and disallowable expenses according to the Internal Revenue Service.
(329 KB) Download PDF
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MyHumana tools

Visit your secure website on Humana.com to:
  • Check your PCA balance
  • Set up account alerts delivered by text message
  • Request reimbursement from your PCA by check or direct deposit

To access these tools and more, sign in to MyHumana . If you haven't signed up for your secure website yet, register for MyHumana today.

MyHumana Mobile

With MyHumana Mobile, you can check your PCA balance on your mobile device. Use your existing MyHumana sign-in information to access this and more at m.humana.com .

Bring the pharmacy to you

Order your medications online and have them mailed directly to you with mail order pharmacies, like RightSource Mail-Order Rx.

Register with RightSource mail-Order Rx
List of recommended health screenings for women to stay healthy and fit at all ages

Check checkups off your list

Make sure you’re getting the recommended health screenings for women your age.

Find out more about health screenings for women (link opens in new window) 

Live well with HumanaVitality

Earn points for healthy choices and use those points toward rewards that help you save money, feel good, and stay well.

More on HumanaVitality