Medicare supplement
 

Hello, I would like to know if anyone has experience with Humana medicare advantage PPO in the villages? Will it be difficult to find Doctors that will bill Humana? Any help on this subject would be appreciated.

Tri-care, Florida Blue, and United are the only 3 they show on their site as being accepted. I have Blue Cross supplemental coverage so I cannot use their primaries however I can use any of their specialists.

Just to clarify, Medicare Supplement (Medigap) plans and Medicare Advantage plans are two entirely different products. A Medicare Supplement plan will cover the Medicare Part A and Part B co-pays, but you still have "regular" Part A and B Medicare. A Medicare Advantage plan will replace Medicare Part A, Part B, and Part D with one separate plan (Part C). Many people seem to confuse these terms.

You seem to be talking about the Villages Health, a network of Medicare Advantage clinics here in The Villages. That is not what he is asking about. He is asking about a different Medicare Advantage plan through Humana.

Original Poster, you should check with your rep from Humana, or on their website, to see if their network extends into Florida and the availability of doctors here.

My mother had a Humana plan. It worked well when she needed a doctor. However, it was a nightmare when she needed rehab after a hospital stay. The two worst institutions were the only ones they would approve in Sumter County. We have a supplement plan so that we can choose any doctor or facility.

OP, you should also contact SHINE, www.floridiashine.org they offer unbiased information on all of then options for health care and they have local meetings, but I have no idea if these are now being held. The phone number is: 1-800-963-5337.

You can choose any doctor except The Villages Health System Primary Care Doctors. I too have the supplement and found it a little hard finding a primary other than Premier which I will not go back to for any reason. This is a perfect location for a few good younger primary doctors to open a business.

We had HumanaAdvantage plan before we moved here earlier this year. Wanted to stay with them if possible.

Got a recommendation for DR but she would only accept Humana Gold.

Discussed this with the local office and we switched to it and happy with it.

However it is an HMO so we must go thru our primary care DR if we want to see a specialist and typically it will be in her group.

We have been referred to several specialists since we are arrived here and have been happy with all of them.

However in a strange move Humana has closed their local office. Has not been a problem as we deal with their customer service dept, who has treated us well but we find closing of the office to be curious.

I have Humana Medicare Advantage PPO and have had very good luck finding doctors in and near The Villages.

humana
 

have Humana Gold for 4 years and no problems at all

I’ve heard too many unfortunate stories of persons who switched from regular Medicare Parts A, B, and D to an Advantage plan we’re shocked to discover when there was a serious issue just how limited—and limiting—Advantage plans are. As a result, at least until original Medicare is done away with, that is what I am sticking with, along with a Medicare Supplement.

So right. Medicare Regular or original is by far the BEST. Beware of Medicare Advantage. You will be limited. You get what you pay for.

We have Humana PPO and are very happy. Have had no issues finding primary care doctors and specialists. Was a United Healthcare member for many, many years and changed due to good relationship with Shands. This was before UF came into The Villages. Husband just had knee replacement and was handled very well. No plans to change.

You get what you pay for.
Beware

I have Humana PPO
 

We do have it and have had it now for 4 years, happy enough that won’t look at any other plans. All Doctors that we have gone so far take Humana, love the no premium other than the Medicare payment, reasonable copays, had United Health Care PPO before, way too expensive, when I switched to Humana, I saved $400 per month, never again UHC. Love our over the counter drugs that we get free every month. Recommend it highly, had two surgeries at U of F in Gainesville (wanted the best Dr.) and wife had one at Advent in Orlando (again the best Dr, recommended by our MD) no issues, all hospitals here accept it as payment in full, but we chose to go to get it done right the first time, which it was done. Love it!!!!

Are you saying that you had zero cost for the surgeries or you had zero cost because you had hit your out-of-pocket maximum prior to the surgery? The reason I ask is that Medicare Advantage Plans typically have pretty high out-of-pocket maximums (say around $6K).

The more treatment that’s needed later on you will complain about your advantage plan.

My husband and I have had Humana PPO for a number of years - love it!
Never had an issue with doctors, services, or getting services approved.

get fl blue so you can use doctors in villages medicare advantage plan. Leonel Barron 352-729-3442. Dr. Uyen Nguyen 352-674-1710 for primary is the best doctor I've had in my lifetime. she also does osteopathic manipulations; much different and better than Chiro.

Premiums
 

This poster said they paid no premiums; did not say they didn't pay any out-of-pocket costs.

For 2021 the United Healthcare Advantage plan has a $2900 out of pocket limit.

I was essentially asking him if he paid out-of-pocket expenses. Here is his statement:

Recommend it highly, had two surgeries at U of F in Gainesville (wanted the best Dr.) and wife had one at Advent in Orlando (again the best Dr, recommended by our MD) no issues, all hospitals here accept it as payment in full,

By "payment in full", I assumed he meant that the hospitals accepted his Medicare Advantage Insurance as payment in full (i.e. no additional cost). I don't believe this has anything to do with his premiums.

The HMO option has a $2900 out-of-pocket maximum.The PPO option has a $5900 out-of-pocket maximum.

Enter your doctors names on the plan and the medications you are taking and see which plans come up for you specifically and then compare co-pays (best is United Healthcare then Blue Cross PPO compare with Humana PPO) but make sure your Drs are on the plan you choose and that your medications are covered!

The confusion is in how it interacts with the mandated portion of Medicare Parts A and B for which the rate is 144.80 a month for the newbies by CMS. If the plan mentioned covers A B D then is the policyholder paying twice or coordinated with CMS?
Anyone who can do an example would be great. Made the mistake of turning 65 in 2020 and no ability to sit down at Social Security and review this.

How much do you pay for Humana gold ? Is this in addition to CMS part A and B of Medicare of 144.80 per month

Regardless of whether you choose a Supplemental Plan to Medicare (aka Medigap) or choose to signup for a Medicare Advantage Plan (which relieves Medicare of any responsibility for your healthcare costs), you will still pay the $144.80 to Medicare. Typically you will see the following:

Option #1: Medicare plus Supplemental - $144.80 + cost of Supplemental Plan (typically around $150-$200), per month

Option #2: Medicare Advantage Plan - $144.80 + $0 or a small premium, per month

There are, of course, differences between Option #1 and Option #2 with regards to the network, co-pays, out-of-pocket maximums, etc. There are several different Supplemental Plans and numerous Medicare Advantage Plans.

Humana Medicare Advantage PPO
 

Almost everyone in TV will take Humana. I had it for a few years. Liked it. Only changed to get a better rate on specific meds. I had to take. Within TV I have found that most Medicare Advantage plans are accepted by most doctors. If I need to see a specialist that is out of network they will usually work with me and adjust the fees.

Medicare supplement
 

We have had the Humana PPO, which is a Medicare Advantage Plan, for many years and love the fact that we don't need a referral to see a specialist, can travel and still see any doctor in their plan, have never had a problem finding a doctor here. All at Premier Medical accept it I believe as well as many others. You can also use it at the UF Hospital and Specialists. The HMO is not good if you travel which is why we have the PPO.

With Option 1, you would need to add the cost for a prescription drug plan, which is Part D. Option 2 would usually include prescription drugs.

Also, the $144.80 cost is not for everyone. It is based on income and many people pay a lot more than that.

Yes, the Medicare Part B varies with income but the poster seemed to indicate that $144.80 was the amount he would be paying.

Hospital is $250 regardless of days there that is all. Emergency Room is $90, Regular Dr copay is $5, Specialist is $35 those are the copays, never had to pay any more than that (wife stayed 8 days in hospital), I am EXTREMELY happy to the point that I am not even considering anything else, I had United Health Care for 2 years for wife and I $400 per month and we still had copays one of my great mistakes, changed to Humana after that plus we get over the counter meds Free, we order them from Humana

I paid none other than the $250 copay
 

Payment in full is just that, I paid only my copay which hospital was $250.00
With my plan Hospital copay is $250, Specialist is $35, regular MD. Is $5, THAT IS ALL PROVIDING YOUR HOSPITAL IS A HUMANA APPROVED FACILITY (all hospitals here in The Villages, Leesburg, Ocala or Gainesville are approved)

My mother had HUMANA which I think was a PPO. Worked fine for doctors but was disastrous for rehab. They only approved the absolutely worst two facilities in The Villages. I could write a book about her stay.

Message accidentally erased; will repost.

We have both unfortunately have had the need for extensive medical care. With original Medicare and United HealthCare (not to be confused with a United HealthCare Advantage plan), ALL our medical costs are covered IN FULL—no deductibles, no co-pays, no out-of-pocket costs. ZERO.

However, we are paying premiums for this coverage. In addition, we pay for Medicare Part D Prescription Drug coverage, as it’s a great program—for the insurance and pharmaceutical drug industries—not especially for many (most?j seniors. For those with high prescription drug costs, check out the GoodRx app and pharmacy checker . com.

A we’ve heard too many horror stories of seniors who in good health switched to an Advantage plan because it APPEARED to be a,good deal. However, once the inevitable health problems showed up, they discovered (1) how much was NOT covered, and (2) the virtual impossibility of switching back.

All we can suggest is to exercise due diligence. As pointed out by another poster, you get what you pay for....

I have no idea why my post is repeating as a quote. I must have done something wrong, sorry.

I have had it since day 1 and never any issues at all. I have a disability and love it only costs $10. to see a specialist.

We have Humana Choice PPO and yesterday I was refused an appt to get established with a primary Dr because she recently stopped taking patients with Humana Choice, but still takes Humana Advantage. My insurance agent says legally she can't deny services if she accepts Medicare at all. He's checking into this for us, but it definitely has me concerned!

Your insurance agent is wrong.