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Humana Gold Choice – Still Affordable?

Senior Lady with Piggy BankCan the premium for Humana Gold Choice go any higher and still attract new members?

There’s no doubt about it, Humana has been the 800 LB gorilla in the Medicare Advantage market. They have had some attractive offerings since Medicare Advantage plans first became available.

Humana Gold Choice is a very popular plan for Medicare beneficiaries who don’t want network restrictions.

Gold Choice is a private fee-for-service (PFFS) Medicare Advantage plan. A PFFS plan allows members to choose any provider that accepts Medicare assignment. But merely choosing a provider doesn’t necessarily mean that the provider will accept your plan. A provider must accept the plan’s payment terms and conditions. Providers also have the option to accept  a PFFS plan on a visit-by-visit basis.

Humana Gold Choice premiums

PFFS Advantage plans have become known as the plans with the highest monthly premiums. Insurance companies that offer PFFS plans don’t have the luxury of lower provider costs . Insurance companies are able to negotiate rates with providers in return for the providers having access to the companies members.

What would you do if you where Humana?

  • Keep the premium the same and earn less profit?
  • Raise the premium and keep the same level of benefits?
  • Keep the premium at the current levels and reduce benefits?

Another possible scenario would be for Humana to not renew the plan and migrate its members to their Human Choice plan. Humana Choice is a PPO with a strong provider network.

 Many providers have pulled out of the PFFS market due to legislation that  became effective in 2011. Companies that offer PFFS plans also have make available a provider network to the PFFS plan members.

Which Plan is the Best Medicare Advantage Plan?



Should you be worried?

If you have Humana Gold Choice, you have nothing to worry about this year. Even if a company decides to non-renew your Advantage plan  you will still maintain all of the plan’s benefits through the end of the year.

If you have Humana Gold Choice it would be wise to explore your options during the Annual Enrollment Period. Humana is a good company but you may be able to save some money by shopping. Take a look at the Humana Choice as well as other plans available in your area.

 

43 comments

  1. I had Humana Gold Choice for year of 2009. A local representative for Cigna convinced me along wth others to go with Cigna. I have found Humana was and looks like is still a much much better plan. I would like to get brochure along with premium cost for Humana for year 2011, that is on the Gold Choice Plan PFFS. Also I would like to know the enrollment date for me to change to Humana for 2011, brochures on plans and cost.
    Thank you – Mary Sue

  2. Mary Sue, You will be able to submit an application for 2011 Humana Gold Choice beginning on November 15, assuming it will be available in your area. The rates for 2011 Humana Medicare plans are not yet available. This site is not a Humana site, and as such, do not have access to all brochures for each State. You will more than likely receive some marketing materials from Humana Medicare plans beginning in October. You may want to compare the Humana Choice and the Humana Gold Choice plans for 2011.

  3. On October 18,2010, I received an e-mail from Humana informing me that the plan I was enrolled in at the time [Humana Gold Choice (PFFS)] would not be available in 2011 and that I should enroll in another plan.
    After much research on the Internet about other companies and their plans, I went back to the Humana web site and found that the first plan offered was in fact Humana Gold Choice (PFFS).
    Why was I given erroneous information that cost me a lot of time in research and why, since the plan in question was actually available, was I not informed? Why, since I’m already a member of that plan do I now have to make a new application as though I were a brand new member? Frankly, I’m puzzled at all the hoops You make me jump through.
    One more “why”: Why don’t you people have an e-mail address like other reputable companies where we, the members, could ask you a simple question – your pages don’t even have a support or help desk button (W-H-Y ?)

  4. John, I understand your frustration. Although this website is not owned or operated by Humana Medicare, there are articles about Humana and many other company’s products on this site. Here is the link for Humana customer support.

    You mentioned that you received an email informing you of your plans non renewal. CMS requires plan sponsors to use the US Mail to notify members of Service Area Reductions and other factors that may effect a plan’s renewal. It may be possible that the email was not from Humana if you didn’t receive mailed notices and the plan is still available. I hope you get the satisfaction you are looking for. People on Medicare don’t need any more confusion or a run around as it relates to benefits.
    David

  5. Carmine J. Cardillo

    I am a member of Humana Gold Plus H1036-065C (HMO).

    My in-network specialist has recommended that I have rotator-cuff surgery on my sholder.

    I would like to know if my plan covers this surgery and the follow-up rehab.

  6. Carmine, If it is a Medicare covered expense (it should be) your plan will cover the surgery and rehab. The question is to what extent it will be covered. Plan benefits can vary from one area to another with the same plan. I recommend that you contact Humana to find out what cost sharing structure will be required for your procedure.

  7. How much will Humana pay on new prescription glasses and how much on catarac surgery

  8. Ruby, Humana has several Medicare Advantage plans and benefits can vary from one County to the next. Humana Gold Choice is a private fee-for-service plan and will generally afford you less benefits than a Humana PPO plan like Humana Choice PPO or a Humana HMO plan like Humana Gold Plus HMO. With the private fee-for-service plan for cataract surgery you will generally pay 20% to 25% of Medicare covered charges. The same or more than if you had original Medicare only. For eye glasses, expect a small discount not unlike a discount you can receive from numerous membership based programs. The plan actually pays nothing toward glasses, it is only a discount.

  9. With humana gold cutting reimbursement to providers to 50% of medicare in the Tampa area, from the prior 65% of medicare, and those same medicare rates being reduced from 2010-2011 how can humana say the cost of health care is rising? As someone who has worked in the medical billing industry for the past 8 years, not once have we seen an increase in the reimbursement we receive. Each year we are cut lower and lower, and its completely on a take it or leave it basis. With insurance companies all posting record profits last year, how can an insurance justify a rate increase.

    It is not just humana, but since this article is about them, just thought people should really know the truth. Insurance companies are trying to raise premiums while coverages levels put all the cost share to the patient, and then find every excuse to deny claims, with no one saying anything.

  10. Jeffrey, Thanks for your comment. Since all insurance company rate increases must be approved by each State where policies are offered maybe your battle would be easier fought with your State in the form of a vote for someone who is of similar mind. The only way to win against an insurance company is to not purchase their products. Regardless of who gets reimbursed there is plenty of documentation to show that health care costs are rising, and rising faster than other segments of the economy.

  11. I am a member of Humana Gold, and had Influenza B beginning on Mar. 1, 2011, and have had a sinus infection since that time. I have been on 4 antibiotics, a Cat scan, been to an ENT and Oral Surgeon who pulled a back molar thinking it might be absessed. Nothing has helped, still on antibiotics and can tell the infection is reduced some, but still have the drainage, and rotten smell from the sinus infection. Can I expect any help from Humana for the dental part. I do not have their dental ins

  12. Judy, Like all Medicare Advantage Plans Humana Gold is offered County by County and benefits can vary from one service are to another. Call the member services number on your Humana card. I wouldn’t be surprised if your plan does not offer much help.

  13. I had Humana Gold Choice last year. I was cut from the program due to “Lack of providers”. Will Humana Gold Choice be available to me in 2012. I live at Gatzke, MN. Marshall County.

  14. Maxine, All Medicare Advantage plan options will be published online at the Medicare website October 1st. Here are instructions to find plans at medicare.gov.

  15. I have filled out a form for Humana Gold Plus HMO, however, I have a few questions and I haven’t been able to get them answered on any websites I have been on. I am on oxygen and I would like to know if United Medical is a provider or who would be. I also have a question on ordering the 90 day supplies mail order. Do they only send generics or do they subsitute then charge you for name brands?

  16. Alma, Because Medicare advantage plans are offered on a County by County basis the benefits included, the networks, premiums, etc can vary by County. You will need to get the plan’s Summary of Benefits to find the answers to your questions. Visit the Humana Website and locate the plan you are interested in. You should then see a link for the Summary of Benefits.

  17. My grandmother (today) was just denied rehab. The insurance company denied her the rehab even though all of the paperwork was approved by the hospitals physical therapist and the rehab facility agreed to take her. The social worker for the hospital was very confused.

    My father has power of attorney and when he called the company to ask why she was denied he was hung up on FOUR TIMES in one day. An appeal has been already been filed. Your customer services is non existent. Potential customers may want to look at Humana’s reviews on other sites. They are pitiful. Sadly, this appears to be warranted.

    Please feel free to directly e -mail me for my father’s contact information if you really are interested in your customers well being. I cannot believe I have been reduced to posting her information to get this company’s attention.

  18. Karrie Kindl-Valdez

    I am a psychotherapist treating a client with Humana Gold Plus Insurance. He suffers from major depression and improved significantly when Abilify was added to his antidepressant. However, he had to stop the Abilify when Humana changed its prescription coverage requiring him to pay $60/month to fill his prescription which he cannot afford. He had serious side effects from risperdone and had to go off resulting in a week-long hospitalization. We have been trying to find a way to get him back on Abilify, even contacting the manufacturer but his psychiatrist is not cooperating with paperwork required to do this. I am wondering if he would be better off with regular Medicare which appears to cover the cost of Abilify for another client. Any suggestions? We are also having a really difficult time finding a new psychiatrist who accepts Humana Gold Plus because we keep getting conflicting information. Any suggestions? I would like to get him back on the Abilify before he ends up back in the hospital.

  19. Karrie, Regular (original) Medicare does not include drug coverage. All Part D drug coverage is provided by private insurance companies. The other client may have a plan that covers the Abilify. Unless your client is entitled to a Special Enrollment Period to switch into another Medicare Advantage plan which will provide the necessary drug coverage, there is only one option at this time (barring the psychiatrist appealing for coverage).

    There is a dis-enrollment period for people who are enrolled in a Medicare Advantage plan such as the Humana Gold Plus plan you reference. From January 1st through February 14th your client can dis-enroll from his plan and return to original Medicare. He could then find a Part D plan that would cover the drug. visit the Medicare website to locate available plans. The downside would be that he would be subject to the deductibles and copays associated with original Medicare. Which may cost considerably more than the $60 he is unable to afford.

    You could also have him contact the local SHIP office to see if they could intervene with Humana on his behalf.

  20. I am new at this since I have to chose a coverage for 2012 when I will receive medicare this year do to disability condition RA. I have been looking at all option and humana seems to be one of the best. But the eye can only see so much I’m also looking at client reviews. I already have doctors that I’m happy with and will continue with them it is hard to find the right doctor. Is there a list of approved doctors? Is this plan a additional coverage for hospitals. emergency, and of course drugs? Do I have to pay
    a out of pocket amoount before covered?

  21. Marianne, Coverage can vary widely even from the same plan based on which service area you live in. You may have more than one Medicare Advantage plan from Humana available. Since you are new to all this I would recommend that you consult with an insurance agent that represents several insurance companies. Reading reviews on Medicare advantage plans can be very misleading since coverage can vary so much from area to area.

  22. I have asked question several times with no answer. Should be simple for experts in field. I switched my medicare supplement to Humana Gold Choice in 2012. Question: Do I still need to carry Medicare with the Humana Gold Choice plan. Don’t know what to do.

  23. Larry, Yes. In order to be enrolled in a Medicare Advantage plan such as Humana Gold Choice you must be enrolled in Medicare Parts A and B. You must continue to pay your Part B premium in addition to any premium required by Humana.

  24. I just joined Humana Gold Plus in Jan.2012.
    I called to make an appt. with the Dr.Humana had assigned to me.
    When I called to make my first appt. I was told Yes,they take Humana Gold Plus, but when I got there they said no.
    I haven’t been able to find one Dr. in the state of OR that takes Humana. Why would they sell me Humana knowing there are no providers. Will I be able to switch to a differant Insurance. Please help

  25. Barbara, Unless you qualify for a Special Enrollment Period or you can demonstrate that you have been misled you will be stuck in the plan until the end of the year. Contact your local SHIP office or the Area Council on Aging to explore your options.

  26. I am with Humana Gold Choice H8145-080 (PFFS).
    I am reading Smart Summary and see “Value-Added Services”,Dental Discount. What does that cover?
    Also Hearing Discount and Vision Discount. What does that cover? What does (ECO) tell me regarding this?

    Any informaion is appreciated.

    Regards,
    Patsy

  27. Patsy, Questions regarding a specific plan and its benefits would best be addressed to an agent authorized to represent Humana in your area.

  28. Rosalee McClure

    Two years ago, Humana was accepted by most all of the major health care providers. Now, only the low rate, no quality back woods providers are accepting Humana. These little Med Centers harbor doctors that are far below the level of top-notch health care providers. They lack the ability to even qualify as doctors as far as I can see. It is March, so can’t change companies now. And this is how it is when politicians play God and decide if we live or die because we really have no choice in our own health care. We have to do as the government tells us, like a bunch of obedient dogs. Humana is only accepted by a bunch of cut-rates who call themselves doctors. Good luck to all of us senior citizens whose very lives depends on the political world who owns and controls our wonderful Medicare Advantage Plans.

  29. Rosalee, You may find a Medicare supplement more to your liking. Check them out during the annual enrollment period. You could eliminate your complaints by purchasing one for 2013.

  30. Can you please give me Humana representative names in the Muskegon area would like to set up a meeting with one to look at changing Humana plan. Thank you

  31. Cherie, I don’t recommend agents. Your best bet is to call a local agency and ask if they represent Humana.

  32. why can’t you or your website provide an answer to a simple question…I NEED A PHYSICAN IN MY NETWORK HUMANA GOLD PLUS (HMO SNP) I EVEN INCLUDED MY STATE TO MAKE IT EASIER FOR YOU ALL. I TRIED TO REGISTER MYSELF ONLINE YOUR WEBSITE DID NOT EVEN REGCONIZE MY SS# NOR MY MEMBER ID#.
    WAKE UP PEOPLE WE NEED INSURANCE NOT IDIOTS WHO SIDE ARE YA’LL ON. WHEN A REP TELLS A CLIENT TO GO ONLINE BECAUSE THEY ARE TOO BUSY THAT SHOWS ALOT OF CARE FOR US.

  33. Cheryl, This site is not owned or operated by Humana. Your anger is misplaced. It would seem as though you need someone to help. Contact your local Area Council on Aging office… they will be able to help you.

  34. Humberto Valenzuela

    What is coverage on knee replacement and rehab?

  35. I just signed up for Humana Gold Medicare and do not see any Psychiatrists listed. However, on all the other plans they are. I tried calling and the lines are so busy. I am a senior with severe anxiety lately and I am sure my Primary will want me to see someone as my depression is very bad lately. Why are there no psychiatrists?

  36. Harriet, Due diligence is required prior to signing up. Sorry your faced with this lack of provider problem.

  37. does humana gold offer in house rehab after hip replacement surgery- or is it limited to out patient therapy

  38. Doraine, I’m not sure. Your doctor who would make the referral to the rehab provider should have some experience with this. You could also call member services to make your inquiry.

  39. I am in Fl and was just told that all of FLORIDA HOSPITALS WILL NOT EXCEPT HUMANA any more. What are we to do Now

  40. Judy, If this is true (and I’m not sure it is) you could exercise your option to dis-enroll from your Advantage Plan (Jan 1 – Feb 14), return to original Medicare with the option of buying a supplement.

  41. Can I change from Humana Gold Plus (HMO) to Humana Choice (PPO) during this year. I am limited on hospitals and Dr. that are in my area. 75862

  42. Douglas, Unless you are entitled to a Special Enrollment Period you will have to wait until the next enrollment period.

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