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#1
Old 01-23-2013, 12:44 AM
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Join Date: Oct 2001
Location: Atlanta
Posts: 1,200
Can someone explain 'Humana' and why it's good or bad vs. normal Medicare?

This question is due to the recent mental health issues with my father i've posted about in another thread. Here's the thread if you're interested :http://boards.academicpursuits.us/sdmb/...d.php?t=678570 although the specifics don't really matter in regards to this question.

I'm trying to keep his financial affairs in order while he's in the hospital and he's getting letters from Humana saying they reviewed the request for treatment and it was approved etc. A letter arrives every few days saying Approved and will be reviewed again on X date.

What is the benefit of Humana vs normal Medicare? (he's 65, although he took social security at 62). I remember him telling me he had gone with Humana a few years back and he felt it was better but I didn't really ask him for specifics. Insurance is a boring conversation and I just figured you know whats best for yourself.

I've reviewed his policy and i'm trying to figure out how this works. I really don't know many specifics on how Medicare itself works. Is it the coverage he would get from Medicare can be shifted to this for profit company? The coverage on his plan looks reasonable I suppose but what advantage would they be able to give over Medicare? Their website claims they are able to provide a better range of services, more choices, but my cynical side says of course they're gonna make that claim.

Anyone have experience in this area? Anecdotal stories are fine. Are these type companies a bit of a scam on the elderly? No scam, but not right for everyone? Perfectly legit and a better choice than Medicare?

Last edited by Quintas; 01-23-2013 at 12:45 AM.
#2
Old 01-23-2013, 03:37 AM
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Join Date: Sep 2011
Location: Sunny California
Posts: 14,840
Is this Humana policy a "Medicare Advantage" policy? (Or, as my HMO calls it, a "Senior Advantage" policy?) Is it a Medicaid policy? Is it a Medi-Gap policy? Or is a pure private policy that your father (or his company or pension or whatever) is paying premiums for?

Whatever the answers may be the above questions, I don't know much about how they work. But I think those are the questions that more-knowledgeable people would need to ask, in order to help you understand the policy.

Last edited by Senegoid; 01-23-2013 at 03:38 AM.
#3
Old 01-23-2013, 03:43 AM
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Join Date: Oct 2000
Location: NE Ohio (the 'burbs)
Posts: 39,815
Here's the site that explains everything. Especially useful is the "Find health & drug plans" section. You can compare your father's Humana coverage with other plans. You will need a list of your father's medications.

The main mistake you're making is that it's not Medicare OR Humana, it's Medicare PLUS Humana. Since he's 65, he gets Medicare, no matter what. Basically, Medicare covers his hospital expenses. Supplemental insurance, which Social Security will deduct from what he gets every month, covers all outpatient doctors' visits, prescriptions, etc. Most of these involve copays.

When I had open heart surgery back in August, Medicare covered all the expenses - the surgery itself, the after-surgery care while still in the hospital, all the doctors, specialists, testing, etc., with only a $400 copay. But since I came home, all my expenses are covered by my supplemental insurance, again with copays.

And of course, since January 1, all coverage is less and all copays are more. You can thank the government for that.
#4
Old 01-23-2013, 10:06 PM
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Join Date: Nov 2001
Location: Madison, WI
Posts: 36,997
Humana is a for-profit medical corporation that operates insurance plans and hospitals, among other things. Humana offers Medicare supplement plans for procedures and drugs.

As panache45 notes, it is not intended to replace Medicare, but to cover things that Medicare doesn't. So it's not Medicare you want to compare it against, it's other insurance companies that also offer Medicare Supplement policies.

Be aware, there is Medicare Part A, Part B, and Part D. (Don't know what the deal is on the missing C.) Supplement programs often supplement only one of those Parts. So it's possible to have two or three Medicare supplement policies without them being redundant.
#5
Old 01-23-2013, 10:52 PM
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Join Date: Oct 2004
Posts: 2,053
Humana does offer Medicare replacement (Advantage) plans as well as Medicare supplement plans. I don't do Cordination of Benefits at work anymore so I haven't kept up, but the last time I recall Humana "Gold" plans were replacement.

Either way the idea is traditional Medicare has terrible benefits relative to commercial insurance (think 20% coinsurance and $1000 hospital deductable (that might occur several times a year) with no annual out-of-pocket limits) so you either have to be prepared for that or else buy commerical supplemental or replacement coverage (although in practice if you need $100,000 in chemotherapy, which I've have seen bills totalling this amount many times, the providers would likely have to write if off your $20,000 rather than collect from someone that probably doesn't have it). Either way your paying premiums to both Medicare and Humana, the difference is who processes the claims and whose's rules you have to follow, if you have a supplement Medicare (actually a commercial insurance company Medicare contracts with) pays the claims, If you have replacement the commerical company pays them.

Medicare A also has limits when it will simply stop paying. They seem high but it happens all the time and a replacement or supplement plan will continue to cover this too.

It's not good or bad, just additional or different.

Last edited by Mdcastle; 01-23-2013 at 10:57 PM.
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