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How Can I Find a Health-Care Provider Who Accepts a Medicare Plan from Humana?

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Humana is a private insurance company that contracts with Medicare to provide Medicare plan options, including Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans.

If you are enrolled in a Medicare Advantage plan from Humana, it may be important to get your health care from providers who accept your plan. Here’s what you need to know about finding providers who participate in Medicare Advantage plans from Humana.

Medicare Advantage (Medicare Part C) offers an alternative way to receive your Original Medicare (Part A and B) benefits from private, Medicare-approved insurance companies like Humana. A Medicare Advantage plan must offer the same coverage as Original Medicare (except for hospice care, which Part A still provides) and may offer additional services and benefits. You’ll still need to pay your Medicare Part B premium, along with any premium the Medicare Advantage plan requires, in addition to copayments, coinsurance, and deductibles.

Why do I need to use doctors who accept Humana’s Medicare Advantage plans?

Humana’s Medicare Advantage plans contract with a network of health-care providers, including doctors, specialists, therapists, hospitals, labs, imaging centers, and outpatient centers, as a way to lower health-care costs for members. Depending on the plan you are enrolled in, you may be required to get all your care (except for medically-necessary emergency care) from providers in the Humana Medicare plan’s network. For example, if you enroll in a Medicare Advantage HMO (Health Maintenance Organization) plan from Humana, you may need to choose from a network of physicians for your care; with a Medicare Advantage PPO (Patient Provider Organization) plan from Humana, you’ll generally get to choose any doctor who accepts Medicare, but you may pay less for the care you receive from in-network health-care providers.

For example, when you get your care from an in-network provider, your copayment or coinsurance amount is usually considered payment in full for your share of your health-care costs (you may be subject to any applicable plan deductibles). If you get your care out-of-network, your costs may be higher than the contracted amount with network providers.

In some cases, your coinsurance percentage may be higher with out-of-network providers, too. If you normally pay 20% of the charges in-network, for example, you may be required to pay 50% for out-of-network charges. In addition, some out-of-network health-care costs may not contribute to your out-of-pocket costs to meet your plan deductible.

How do I find health-care providers in the Humana Medicare Advantage plan’s network?

If you are already enrolled in one of the Humana Medicare Advantage plans, you can visit this page on the Humana website, which has a doctor-search tool, as well as forms and other guides you may need to manage your plan.

If you are comparing different Medicare Advantage plan options from Humana and want to see if your current doctor is in the Humana network, you can use the above doctor-search tool, which has a “Just Looking” option that does not require a member ID to search for providers.

There is also a MyHumana mobile app for iPhone and Android devices that allows you to search for health-care providers who are in the Humana network using your smart phone or other mobile device.

Do I need to use in-network providers with Medicare Supplement plans?

If you decide to stay with Original Medicare (Part A and B), another option you may have is to sign up for a Medicare Supplement plan to help pay for Original Medicare’s out-of-pocket costs. Different Medicare Supplement (Medigap) plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

Medicare Supplement plans are different from both Medicare Advantage plans and stand-alone Medicare Part D Prescription Drug Plans. Medicare Supplement (Medigap) plans work alongside Original Medicare and generally do not require you to use network providers to access your benefits. However, certain types of Medicare Supplement plans (called Medicare SELECT plans) do have provider networks you may be required to use.

It’s important to remember that Medicare Supplement plans only apply to out-of-pocket expenses for services covered by Original Medicare. Generally speaking, your Medicare Supplement plan cannot be used to pay for routine vision or dental care, hearing aids, prescription medications, or long-term custodial care in a nursing home. There may be other exclusions and limitations, so consult your plan brochure if you have questions about your coverage. A good time to enroll in a Medicare Supplement plan is generally the Medicare Supplement Open Enrollment Period.

As mentioned above, Medicare Supplement plans do not include prescription drug coverage. If you need help with prescription drug costs, you may want to consider enrolling in a stand-alone Medicare Part D Prescription Drug Plan from Humana. Fall Open Enrollment is the Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage. If you have any questions about your Medicare plan options, feel free to call us at the number listed below and talk to one of eHealth’s licensed insurance agents.

Out-of-network/non-contracted providers are under no obligation to treat Humana members, except in emergency situations. For a decision about whether Humana will cover an out-of-network service, we encourage you or your provider to ask Humana for a pre-service organization determination before you receive the service. Please call Humana’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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