Jane Dotson
Humana, a private health insurance company, has decided to exit the commercial health insurance market and focus on government-sponsored products such as Medicare Advantage. This means that Humana will no longer offer fully-insured or self-funded employer plans or any associated wellness and rewards programs. Instead, the company will direct its efforts towards government-funded programs like Medicare, Medicaid, and Military plans, as well as specialty businesses and integrated value-based care. This strategic shift is expected to enable Humana to focus its resources on areas with greater growth opportunities and enhance its value proposition for members and customers.
| Characteristics | Values |
|---|---|
| Type of insurance | Medicare Advantage |
| Company | Humana |
| Company focus | Government-sponsored products |
| Commercial market | Exited in 2023 |
| Group Medicare Advantage plan | $0 copays for many healthcare services, including preventive care and primary doctor's visits |
| Group Medicare Advantage plan | No annual deductible |
| Group Medicare Advantage plan | One of the largest PPO networks |
| Group Medicare Advantage plan | Passive PPO plan |
| Group Medicare Advantage plan | More prescription drug options |
| Group Medicare Advantage PPO plan | Does not include access to the Employee Assistance Plan (EAP) |
| Group Medicare Advantage PPO plan | Includes benefits for inpatient and outpatient mental health services |
| Group Medicare Advantage PPO plan | Includes worldwide benefits for emergencies |
| Group Medicare Advantage PPO plan | Includes routine vision and hearing benefits |
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What You'll Learn
Humana Group Medicare Advantage PPO plan
Humana has exited the commercial health insurance market to focus on government-sponsored products, such as Medicare Advantage. One such product is the Humana Group Medicare Advantage PPO plan.
The Humana Group Medicare Advantage PPO plan is a group Medicare Advantage plan, which is different from individual Medicare Advantage plans available on the local market. The plan has one of the largest PPO networks, and it is a passive PPO plan, meaning that members can go to any provider that accepts Medicare and will bill Humana. This provider will be reimbursed at 100% of the Medicare-allowed amount.
The plan includes all the benefits of Original Medicare (Parts A and B) and covers medically necessary items and services from a large national network of hospitals and physicians. It also covers any doctor, specialist, or hospital that accepts Medicare and agrees to bill Humana. The plan covers medication in four tiers, with a $5 copayment for Tier 1 Generic or Preferred Generic prescription drugs. Out-of-pocket prescription expenses are capped at $2,000 annually, after which the plan pays 100% of your total drug costs for the remainder of the year.
The Humana Group Medicare Advantage PPO plan also offers additional benefits such as dental, vision, and hearing aid benefits, as well as a variety of wellness, clinical, and fitness programs. For example, the plan covers routine vision and hearing exams, as well as part of the cost for hearing aids, up to one per ear per year, prescribed by an audiologist. It also includes worldwide benefits for emergencies.
In 2025, retired members pay no monthly subscription rate to participate in the plan.
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$0 copays for many healthcare services
Humana is exiting the commercial health insurance market to focus on government-sponsored products, such as Medicare Advantage. The insurer will phase out its fully insured, self-funded, and Federal Employees Health Benefits Program plans, as well as its wellness and rewards offerings.
The Humana Group Medicare Advantage PPO plan offers $0 copays for many healthcare services, such as preventive care and primary doctor's office visits, and there is no annual deductible. The plan also includes benefits for mental health services provided on an inpatient basis, as well as outpatient mental health services provided by a state-licensed psychiatrist or doctor, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, physician assistant, or other Medicare-qualified mental healthcare professional as allowed under applicable state laws.
The plan also includes a routine vision benefit with EyeMed Insight as the in-network provider. This benefit includes a routine vision exam with refraction (up to one per year) and a combined annual benefit for contact lenses and glasses (lenses and frames). The plan also covers one routine hearing exam per year, as well as part of the cost for hearing aids, up to one per ear per year, prescribed by an audiologist.
Additionally, the Humana Group Medicare Advantage PPO plan includes worldwide benefits for emergencies. If you have an emergency outside of the US and its territories, you will need to pay for the services upfront and then submit a claim to Humana for reimbursement.
It is important to note that the $0 copay and $0 monthly premium offerings are not entirely free, as there may still be costs for deductibles and copays for covered services, and you will need to pay the Part B premium. However, depending on your personal healthcare needs, a Medicare Advantage plan may be worth it for the added benefits.
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Worldwide emergency coverage
Humana is a health insurance company that offers Medicare Advantage plans, also known as Part C, which cover the same medical services and supplies included in Original Medicare Parts A (hospital insurance) and B (medical insurance). These plans are available in 47 states and Washington, D.C.
The Humana Group Medicare Advantage PPO plan includes worldwide emergency coverage. If you experience a medical emergency outside of the U.S. and its territories, you will need to pay upfront for the services and then submit a claim to Humana for reimbursement. This claim must include proof of payment, an itemized bill, a physician order (if applicable), and medical records.
It is important to note that the specific coverage details of your plan may vary depending on where you live. Additionally, traditional Medicare Parts A and B do not cover foreign travel. Therefore, it is recommended to carefully review the terms of your insurance plan, including how it addresses out-of-network providers, medical evacuation, and associated co-pays.
If you are unsure about the overseas coverage provided by your Humana plan, it is best to contact Humana directly to obtain a definitive answer.
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Routine vision and hearing benefits
Humana has exited the commercial health insurance market and is now focusing on government-sponsored products like Medicare Advantage. The Humana Group Medicare Advantage plan includes routine vision and hearing benefits.
Routine Vision Benefits
Humana's Medicare Advantage plans offer routine vision coverage as part of their benefits. Vision coverage is included in some of Humana's Medicare Advantage (Part C) plans. This includes Vision Plus, an enhanced supplemental benefit that provides an additional vision allowance when members use a PLUS provider for their eye care. Routine vision benefits include a routine vision exam with refraction (up to one per year) and a combined annual benefit for contact lenses and glasses (lenses and frames). Depending on your Humana Medicare Advantage plan, you may be required to visit a vision care provider within your plan network to get full coverage.
Routine Hearing Benefits
Humana's Group Medicare Advantage plan covers one routine hearing exam per year, as well as part of the cost for hearing aids, up to one per ear per year, prescribed by an audiologist. To receive this benefit, you must use a TruHearing provider.
For more information on Humana's routine vision and hearing benefits, please refer to the official Humana website or contact their customer support.
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Humana's exit from the commercial market
Humana Inc. has announced that it will exit the Employer Group Commercial Medical Products business, which includes all fully insured, self-funded, and Federal Employee Health Benefit medical plans. The company plans to phase out these offerings over the next 24 months. This decision will leave nearly 1 million members seeking new insurance carriers, particularly in states like Florida, Texas, Georgia, and Kentucky, where Humana's commercial business is concentrated.
In a statement, Humana explained that the Employer Group Commercial Medical Products business was no longer positioned to sustainably meet the long-term needs of commercial members or align with the company's strategic plans. This line of business generated over $4 billion in revenue in 2022, a relatively small portion (less than 0.05%) of the company's total revenue. Despite this, Humana does not anticipate the exit from the commercial market to impact its financial performance in the immediate year.
Humana's decision to exit the commercial market and concentrate on government-funded insurance reflects a strategic realignment. By focusing on Medicare Advantage and related products, Humana is prioritizing a market segment that already had 5.1 million individual Medicare Advantage members at the end of 2022. This shift in focus underscores the company's commitment to long-term growth in its core insurance lines of business and adapting to the evolving healthcare landscape.
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Frequently asked questions
The Humana Group Medicare Advantage plan is a group Medicare Advantage plan, which is different from individual Medicare Advantage plans. It offers $0 copays for many healthcare services, such as preventive care and primary doctor’s office visits, and has no annual deductible.
The plan includes worldwide emergency benefits and covers routine vision and hearing exams. It also offers benefits for mental health services provided on an inpatient basis, as well as outpatient mental health services provided by a licensed professional. Additionally, the plan has a larger prescription drug formulary than standard individual formularies.
If you have multiple types of insurance, each type of coverage is called a "payer". The primary payer pays up to its limit, then sends the remaining balance to the "secondary payer". If the secondary payer doesn't cover the remaining balance, you may be responsible for the remaining costs.
No, Humana has exited the commercial health insurance market and is focusing on government-sponsored products and Medicare Advantage.
