Orlando Harmon
Humana is a private health insurance company that offers Medicare Advantage plans, including HMO, PPO, and PFFS, as well as stand-alone PDP prescription drug plans. The company also provides Medicaid and military health coverage. In late 2022, Humana announced its decision to exit the commercial health plan business and focus on government-funded programs and specialty businesses. This shift in strategy is expected to occur over the next 18 to 24 months. As of September 30, 2022, Humana had 8.7 million Medicare members across the United States, with more than half enrolled in a Medicare Advantage plan. The company has been in operation since 1961 and is the third-largest healthcare company in the US, serving over 13 million customers.
| Characteristics | Values |
|---|---|
| Type of company | Health insurance company |
| Company focus | Medicare, Medicaid, Military, and specialty businesses |
| Company strategy | Focus on government-funded programs |
| Number of Medicare members | 8.7 million |
| Number of states | 50 |
| Medicare members in Washington, DC, and Puerto Rico | Yes |
| Medicare Advantage (MA) plan members | 5.1 million |
| MA growth from 2022 to 2023 | 6.8% |
| Percentage of MA members enrolled in plans with 4 stars or above | 96% |
| MA plan benefits | Dental, vision, fitness memberships, etc. |
| Humana's network | 350,000 medical providers and over 3,000 hospitals |
| Number of customers | 13 million |
| Types of plans | HMO, PPO, POS, EPO, and SNP |
| Individual coverage | Yes |
| Dental insurance | Yes |
| Vision coverage | Yes |
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What You'll Learn
Humana is exiting the commercial health plan business
Humana Inc. has announced that it will be exiting the Employer Group Commercial Medical Products business, which includes all fully insured, self-funded, and Federal Employee Health Benefit medical plans, as well as associated wellness and rewards programs. This decision does not affect any other Humana health plan offerings.
The company's strategic review determined that the Employer Group Commercial Medical Products business was not positioned to sustainably meet the needs of commercial members in the long term or support the company’s long-term strategic plans. As a result, Humana will be moving out of commercial plans over the next 18 to 24 months and will instead focus on government-funded programs and specialty businesses.
The company remains committed to the long-term growth of its core insurance lines of business, including Medicare Advantage, Group Medicare, Medicare Supplement, Medicare Prescription Drug Plans, Medicaid, Military, and Specialty (Dental, Vision, Life, etc.). Humana will also continue to expand its CenterWell healthcare services business, which offers payer-agnostic, senior-focused primary care services in several states, including Indiana, Kentucky, Louisiana, Mississippi, Nevada, North Carolina, South Carolina, Tennessee, Texas, and Virginia.
As of September 30, 2022, Humana had 8.7 million Medicare members across all 50 states, Washington, DC, and Puerto Rico. More than half (5.1 million) of those members were enrolled in a Medicare Advantage (MA) plan. Humana has been identified as one of the drivers of MA growth, with a 6.8% increase in enrollment from 2022 to 2023. The popularity of MA plans can be attributed to the extra benefits they offer, such as dental, vision, and fitness memberships.
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Humana's Medicare Advantage plans
Humana is a private health insurance company that offers Medicare Advantage plans, also known as MA plans. These plans are an alternative to Original Medicare, offering additional benefits and services. As of 2022, Humana had 8.7 million Medicare members across all 50 states, Washington, D.C., and Puerto Rico. More than half of these members, approximately 5.1 million, were enrolled in a Medicare Advantage plan.
Medicare Advantage plans from Humana provide all the benefits of Original Medicare Parts A and B, and most plans include coverage for prescription drugs. Additionally, these plans often include extra benefits such as dental, vision, and fitness memberships, making them attractive to Medicare beneficiaries. Humana's PPO plans allow enrolleers to visit any Medicare-approved doctor who accepts the plan's terms.
One of the key advantages of Humana's Medicare Advantage plans is the limit they set on out-of-pocket expenses. Once a member reaches this limit, they pay nothing for covered services for the rest of the plan year. This feature provides financial predictability and peace of mind for members.
In addition to these benefits, Humana provides services such as Medication Therapy Management, where qualified members can receive a free medication review with a pharmacist or other health professional. The company also assists members in determining their eligibility for the Medicare Savings Program in their state and offers Medication Reconciliation, which ensures an individual's medication list is accurate and up-to-date.
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Humana's Medicaid plans
Humana is a private health insurance company that offers Medicare and Medicaid plans. Medicare is a federal health insurance program available to most people aged 65 and older and some people under 65 with specific disabilities. On the other hand, Medicaid is a public health insurance program available to people of any age who meet income guidelines, qualified families and children, pregnant women, seniors, and people with disabilities.
Medicaid is administered by the federal government and individual state governing agencies. Each state runs its own Medicaid program and decides who is eligible. Many state agencies team up with private health insurance companies like Humana to provide extra benefits and services to their members. Humana has been offering Medicaid plans since the 1980s.
Humana offers Medicaid plans in states where it has a contract with the state Medicaid program. The company provides an online portal, MyHumana, which allows members to access secure plan information, claims, in-network providers, and drug pricing. Humana also provides free language interpreter services.
In late 2022, Humana announced its plan to expand CenterWell, which offers senior-focused primary care services, to several states, including Indiana, Kentucky, Louisiana, Mississippi, Nevada, North Carolina, South Carolina, Tennessee, Texas, and Virginia. This expansion demonstrates Humana's commitment to growing its government-funded programs, including Medicaid.
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Humana's dental and vision plans
Humana is a private health insurance company that offers Medicare plans, which are available to people aged 65 and over and to some people under 65 with specific disabilities. Humana also offers Medicaid plans, which are available to people who meet income guidelines, qualified families and children, pregnant women, seniors, and people with disabilities.
In addition to Medicare and Medicaid plans, Humana offers dental and vision insurance plans for individuals and families. These plans are insured or offered by various subsidiaries and affiliate companies of Humana Inc., such as Humana Insurance Company, HumanaDental Insurance Company, and The Dental Concern, Inc. These plans are not available in all states, and the benefits may vary by state. For example, in Texas, Humana offers a plan that provides benefits for both contracted and non-contracted dentists, while in Colorado, they offer the Network Access Plan, which is specific to the member's network.
Overall, Humana's dental and vision plans offer a convenient way to access dental, vision, and hearing care, with the added benefit of combining them into one plan. The availability and specifics of the plans may vary by state, so it is important for individuals to check the plans offered in their specific state.
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Humana's military focus
Humana is a private health insurance company that offers Medicare plans to eligible US citizens aged 65 and over, as well as to some people under 65 with specific disabilities. Medicare is a federal health insurance program that provides coverage for a range of healthcare services.
In addition to Medicare, Humana also offers Medicaid plans. Medicaid is a public health insurance plan that provides coverage for people who meet certain income guidelines, qualified families and children, pregnant women, seniors, and people with disabilities. It is administered by the federal government and individual state governing agencies.
In late 2022, Humana announced that it would be exiting the commercial health plan business to focus on government-funded programs and specialty businesses. This includes a focus on Medicare Advantage plans, which have been popular among Humana's customers due to the extra benefits they offer, such as dental, vision, and fitness memberships.
As part of its strategic shift, Humana also expressed its intention to focus on military-related programs. While the company has not provided specific details on its military initiatives, Humana's commitment to advancing its leadership position in integrated value-based care and expanding its healthcare services suggests a potential alignment with military healthcare needs.
Humana's decision to exit the commercial market and concentrate on government-funded programs, including military-related initiatives, underscores its commitment to delivering industry-leading value to its members and customers. By specializing in these areas, Humana aims to better utilize its resources and meet the evolving needs of its clientele.
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Frequently asked questions
Humana is a Medicare Advantage HMO, PPO, and PFFS organisation and a stand-alone PDP prescription drug plan. It is also a Coordinated Care HMO SNP and PPO SNP plan with a Medicare contract and a contract with the state Medicaid program. Humana is also the brand name for plans, products, and services provided by subsidiaries and affiliate companies of Humana Inc.
No, Humana is not only for Medicare. Humana is exiting the commercial health plan business to focus on government-funded programs like Medicare Advantage, and specialty businesses. Humana also offers Medicaid plans and military health plans. Additionally, Humana offers individual dental and vision plans and insurance for individuals and families.
Humana's Medicare Advantage plans cover extra benefits like dental, vision, and fitness memberships, which are not covered by original Medicare. Humana's Medicare plans also provide access to MyHumana, which makes it easy to access ID cards, claims, in-network providers, and drug pricing.
