Note Important Information for Dual-eligible Benefit Coordination

Participating healthcare practitioners who provide medical services to patients with Humana Medicare Advantage (including Value Plus Plan) coverage – some of whom may have dual eligibility – need to be aware of the following information about benefit coordination:

  • Medicaid may cover costs and services not covered under the Medicare plan.
  • Dual-eligible patients should provide both their Humana ID card and a state-issued Medicaid card.
  • For these cost-share-protected patients, physicians and other healthcare providers should submit medical claims to the address on the back of the member ID card for payment of Medicare-covered services.
  • For physicians and other healthcare providers who are contracted with Medicaid, any remaining cost must be submitted to Medicaid for review and payment consideration.
  • These patients are not responsible for plan-covered:
    • Copayments
    • Coinsurance
    • Deductibles
    • Part B drugs
  • Any additional cost share for Part A and B services must be submitted to the Medicaid payer.
  • The amount paid by Humana and Medicaid must be accepted as full payment due to the cost-share protection.
  • Patients who are cost-share protected may not be balance-billed.

For questions about Humana plan eligibility and benefits, please refer to Availity.com (link opens in new window) or call 1-800-457-4708, Monday through Friday, 8 a.m. to 8 p.m. Eastern time.