Will My Medications be Covered by a Medicare Plan with Prescription Drug Benefits from Humana?

If you take prescription medications on a regular basis, or have chronic health conditions that require treatment with prescription drugs, you may want to make sure your medications are covered by a Medicare plan that includes prescription drug coverage, such as those available from Humana.

Read on to learn about Humana’s Medicare prescription drug benefits and how to find out if your medications will be covered.

Which of Humana’s Medicare plans include prescription drug coverage?

Humana is a private insurance company contracted with Medicare to provide health care and prescription drug benefits to members. For this reason, not all plan types and benefits may be available in all areas, and you may have different premiums, copayments, coinsurance amounts, and deductibles depending on the plan you choose and where you live.

There are two types of Medicare plan options available from Humana that offer prescription drug coverage:

  • Humana Medicare Advantage Prescription Drug plans
  • (Stand-alone) Humana Medicare Part D Prescription Drug Plans

Medicare Advantage (Part C) is an alternative way to get your Original Medicare benefits; a Medicare Advantage Prescription Drug plan must cover everything that Original Medicare covers, except for hospice care, which is still covered by Part A. Most of Humana’s Medicare Advantage plans include prescription drug coverage. Many Medicare Advantage plans from Humana have optional extra benefits you can add to your plan, such as routine vision and dental. If you enroll in a Medicare Advantage Prescription Drug plan, you must continue to pay your Medicare Part B premium plus any additional premium required by your plan. Copayments, coinsurance, and deductibles may also apply.

If you decide to remain with Original Medicare (Part A and B) and need help with prescription drug costs, you may want to consider enrolling in a stand-alone Medicare Part D Prescription Drug Plan from Humana. Original Medicare generally doesn’t cover prescription drugs; a Medicare Prescription Drug Plan may help lower your prescription drug expenses now and in the future.

How do I check which medications are covered by Humana’s prescription drug benefits?

To understand prescription drug coverage under a Medicare plan from Humana, you need to know some terms that may be unfamiliar to you, such as:

  • Formulary. A formulary is a list of prescription drugs the plan will cover (according to plan rules). Note: Plans may change their formularies at any time, but you’ll receive notice when necessary.
  • Prior authorization. Some formularies require you or your provider to get approval from the Humana Medicare plan before prescribing the medication. Your provider may also need to show the prescription drug is medically necessary.
  • Tiered formulary. Some Humana Medicare Advantage plans and Medicare Prescription Drug Plans use a tiered formulary, which assigns lower copayments, coinsurance, and/or deductibles for less expensive medications, such as generic prescription drugs. A tiered formulary typically requires more cost sharing for medications in higher tiers, usually expensive brand-name drugs.
  • Step therapy. In some cases, your Humana Medicare Advantage plan may require your doctor to start you on a less expensive prescription drug to test your response to treatment before approving a more expensive one.
  • Quantity limits. A plan may limit the number of doses or pills you can obtain at a time.

To see if a Humana Medicare Advantage Prescription Drug Plan or a stand-alone Humana Medicare Part D Prescription Drug Plan covers your prescription medication, you can see this page and use the Drug List Search tool, or view a printable list of covered medications (and any required conditions, such as prior authorization or quantity limits that may apply).

Please note that some prescription drugs may be available at lower costs through a mail order pharmacy, and some may need to be filled through a specialty pharmacy.

If your prescription drug isn’t covered by your Humana Medicare Advantage plan or Humana Medicare Prescription Drug Plan, your doctor may request an exception to the plan’s formulary.

How do I find a Humana Medicare Advantage Prescription Drug plan or stand-alone Medicare Prescription Drug Plan that covers my medications?

  • To view the different types of Humana Medicare plans that may be available in your area, just enter your zip code in the form on this page.
  • If you have questions about Humana Medicare Advantage plan options with prescription drug coverage or stand-alone Prescription Drug Plans from Humana, please call one of our licensed insurance agents at the phone number found on this page.

Humana is a Medicare Advantage HMO, PPO, and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana Medicare plan depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or member cost-share] may change on January 1 of each year.

You must continue to pay your Medicare Part B premium.

The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.

Humana’s pharmacy network offers limited access to pharmacies with preferred cost sharing in urban areas of < AL, CA, CT, DC, DE, IA, IL, IN, KY, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NH, NJ, NY, OH, OR, PA, RI, SC, SD, TN, VA, VT, WA, WI, WV; suburban areas of AZ, CA, CT, DE, HI, IL, MA, MD, ME, MI, MN, MO, MT, ND, NH, NJ, NY, OH, OR, PA, PR, RI, VT, WA, WV >; and rural areas of < AK, IA, MN, MT, ND, NE, SD, VT, WY > . There are an extremely limited number of preferred cost share pharmacies in urban areas in the following states: < DE, MA, MD, ME, MI, MN, MS, ND, NY, OH, SC, and VT> ; suburban areas of: < MT and ND > ; and rural areas of: < ND >. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, please call Customer Care at <1-800-281-6918 (TTY: 711)> or consult the online pharmacy directory at Humana.com.

Humana MyOption optional supplemental benefits (OSB) are only available to members of certain Humana Medicare Advantage (MA) plans. Members of Humana plans that offer OSBs may enroll in OSBs throughout the year. Benefits may change on January 1st each year.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

Last Updated Date: 7/30/2017


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