What is a Humana Medicare Supplement Plan?

As you become eligible for Medicare, you may want extra coverage to help pay for medical costs that Original Medicare doesn’t cover. This is where a Medicare Supplement plan, also called Medigap, can help. Humana offers several Medicare Supplement plans, also known as Medigap plans, to choose from.

Medicare Supplement plans are private health insurance policies sold by companies like Humana. They help cover costs that Original Medicare Parts A and B don’t pay for like copayments, coinsurance, and deductibles. With a Medicare Supplement plan from Humana, you’ll pay a monthly premium but have fewer out-of-pocket costs when you need care.

The Different Humana Medicare Supplement Plan Options

Humana offers plans A, F, G, N, and High Deductible F for Medicare Supplement coverage. Each plan covers different benefits to fill gaps in Original Medicare coverage.

  • Plan A is basic coverage that pays your Part B coinsurance or copayment amount.
  • Plan F is the most comprehensive plan. It has no deductibles and covers all Part A and B coinsurance and copayment amounts.
  • Plan G is similar to Plan F but you must pay a deductible for Part B benefits before the plan starts paying.
  • Plan N covers the Part A hospital coinsurance amount and most of the Part B coinsurance amount after you pay a copayment.
  • High Deductible Plan F works like regular Plan F but you must pay a deductible before the plan covers costs.

Choosing the Right Humana Medicare Supplement Plan

When choosing a Humana Medicare Supplement plan, consider:

  • Your health needs and how often you may need medical care
  • Any prescriptions you take regularly and your out-of-pocket costs
  • Your budget and ability to pay premiums and any copays or deductibles

Getting a quote from Humana can help you compare plans and costs. Plan F generally has the highest premiums but very low out-of-pocket costs when you need care. A High Deductible plan may have lower premiums but you pay more initially. Choose the plan that best fits your health needs and budget.

FAQs:

Q1. What are Medicare Advantage plans?

Medicare Advantage plans are private insurance alternatives to original Medicare offered by large insurers. They provide Medicare Part A and B coverage, and sometimes extra benefits like dental or vision. The government pays the plans a set amount per enrollee.

Q2. How do Medicare Advantage plans get paid?

A: Medicare Advantage plans are paid by the government on a capitated basis, meaning they receive a set monthly premium for each enrollee. The amount varies based on factors like age, gender and health status. Plans receive higher rates for sicker patients.

Q3. What issues have audits found with payments?

Audits have found that some Medicare Advantage plans may be exaggerating how sick enrollees are in order to receive higher payment rates from the government. This has led to billions in improper overpayments in some cases.

Q4. How do payment denials impact rural hospitals?

Medicare Advantage plans frequently deny claims from rural hospitals, pushing more costs onto these providers. This threatens the financial viability of many safety-net hospitals, especially in small towns where they may be the only provider. Some rural hospitals have even had to shut down services or close due to the denials.

Q5. What is the goal of the new OIG audits?

A: The new wave of audits from the OIG aim to hold Medicare Advantage plans accountable for improper payments for the first time. By requiring plans to repay overpayments identified in the audits, the goal is to reduce healthcare costs for taxpayers and ensure payment accuracy.

Q6. How much money could be recovered?

The audits could potentially recover tens of millions, or even billions, of dollars in overpayments if extrapolation methods are upheld. The Humana audit alone seeks nearly $200 million in repayments dating back to 2015. Multiple audits of other plans are expected in the next 1-2 years.

Q7. How are the plans responding?

A: The industry is strongly opposing these audits and the use of extrapolation to estimate overpayments. Plans argue the methods violate payment rules and dispute the findings. They will likely fight hard to avoid repaying any funds identified through appeal and legal challenges. It remains uncertain if regulators can successfully recover much money.

Conclusion

Medicare Advantage plans have grown rapidly in popularity as an alternative to traditional Medicare coverage. However, audits have found that some plans may be overbilling the government by exaggerating how sick enrollees are. This leads to billions in improper payments each year. While the plans offer extra benefits, they also frequently deny claims from rural hospitals. This threatens the financial viability of many safety-net providers in small towns. \

The new wave of audits from the OIG aim to hold Medicare Advantage plans accountable for the first time by requiring repayment of overpayments. This could help reduce healthcare costs for taxpayers. However, the industry is fighting back against audit methods like extrapolation. It remains to be seen if regulators can successfully recover funds and improve the accuracy and fairness of Medicare Advantage billing practices.

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