[doodlebee]

Well, I'm kind of running late on this since it's the last day to enroll, but...

I'm wondering if anyone has any experience with Humana insurance? I'm looking into their PPO Medicare Advantage plan to replace Medicare Part A & B. The benefits and providers look good, but I'd like to know if anyone has experienced any problems with Humana claims, or if it's a good company.

 

[Maia]

I have no direct personal experience, but I have not heard great things about this company. You can always google search "humana medicare reviews" and see what comes up.

Do you have lupus? Welcome to our site.

 

[doodlebee]

Thank you, Maia. Yes, I do have lupus...sorry, I should have done a little introduction since this was my first post, but I was in a hurry. I was diagnosed with lupus in March 2008, though I've had symptoms for 20 years or more (more about that later).

I went ahead and enrolled with Humana since this was the last day, but would still like to hear other people's experiences with it. I think if I'm not satisfied with it, I can cancel within the first 3 months, but after that I'll be stuck with it until next year. Guess we'll see how it goes. The benefits definitely look better than original Medicare...that is IF Humana actually pays its claims and doesn't cause a lot of headaches.

If anyone does have any input or personal experiences, I would sure like to hear them.

 

[sam101360]

I would suggest that you do some serious re-thinking...I am sorry that this post is late, but believe hyou have until March 31st to change your option.

Humana, as my Dr has told me, payts Dr's not to refer patients. The less they do, the more the primary care physician makes.

Most of my Dr's will not accept Humana as they feel that the patient is not well cared for under this plan. Now I am in Florida, and it may be different elsewhere, however, the bestway to choose a plan, is to ask a Dr you are most happy with, what plan they would recommend for their family if they were in your situation.

I found that most Dr's have the same thoughts about plans, and they all participate in the ones that they feel most comortable with.

Here in Florida we have SHINE councellors who will input your medication, illness and fequency of Dr visits and make recommendations about which plan gives the best coverage.

The big issue for us, seems to be part D medication. Many of our meds are non formulary so we pay much higher co-payments, they may not be covered at all, and the GAP can be devistating...(the length of the period where you need to pay full price for medications) before catastophic cost requirements have been met.

Any plan you consider, you should definately call up, provide a list of medications, dosages (mg) and amount used, then ask them to provide your monthy medication costs, when you will hit the GAP, medication costs in the GAP and finally how long the GAP will last. Then you can determine which plan will cover you with the least out of pocket.

Also, are your DR's in the plan? How much are your visits? Are they limited in the course of the year? If so, how do you manage the visits that are not covered. How many lab tests are covered (yes they limit these as well).

All of this should be added up, plus the premium you play...and compared to othe plans that may caost a monthly premium...you need to figure the net difference and see which makes more sense.

Insurance is a huge management issue for us as our care can vary so much, our meds are so expensive and we need to plan for any contingency.

Wow, I am sorry that i got on my soap box, however I just went through this with my in-laws, parents and myself (as I got approved for SSDI). it's very complicated and the wrong decision can cost alot of money, or as in m y fathder-in-laws case, almost his life (HUMANA did not cover the procedure required to save his life - nor did they cover the appropriate re-hab afterwards)

I hope this helps, feel free to IM me if I can offer anymore assistance.

Stephanie

 

[emu]

Hi Doodle,

I have a friend whose aunt is very happy with Humana. I looked into it on the internet and heard not such good reports. But I wonder who to believe. You, too, might find Humana very supportive of your medical needs.

I am/was (missed the deadline) looking for a company that will assist with the Part D (donut hole problems) meds throughout the year.

I will have to stick with what I have which is a local company that covers all medical with very reasonable copays and covers drugs up to $1500. That drug coverage lasted me about 2 months last year. We do have a place called the sample clinic that covers some meds free for 3 months out of the year which helped. The medical coverage is good - I had outpatient surgery for no fee. It is the medication that breaks your pocketbook.

There are some meds I do not take now because of the costs. Please let us know how Humana treats you.

There is a good site under medicare.gov that will give you all your options in your area if you just fill out a few pieces of information. I don't know how to put the link in but look for "medicare prescription drug plan finder" on that site.

 

[doodlebee]

Thanks for all the input. I really do appreciate it!

The plan I chose with Humana does not have Rx coverage because I had already chosen a separate Rx plan with a different company—AdvantraRx. It covers all my current meds and also has gap coverage (covers generics through the doughnut hole), so I feel pretty good about that.

Some of my doctors are not in the Humana PPO, but I'm willing to change doctors—except for my rheumatologist—I really want to stay with her! If she doesn't join the PPO, then I might just have to pay the out-of-network deductible and copay to see her. I still think this plan would save me money because of the lower copays for everthing else, especially inpatient and outpatient hospital. It also has dental coverage, and I badly need some dental work done.

This plan is also not supposed to require any referrals to see specialists, so that shouldn't interfere with the quality of care I'm getting. The main thing I'm concerned about is if they are reliable and actually process claims the way their policy reads. And believe me, I am going to read every single detail in the policy book when I receive it since all I've seen so far is the summary of benefits.

And let's hope I can change my mind within the first 3 months if it's not going well!

 

[doodlebee]

*Update*

Well...I changed my mind and called today and canceled my enrollment application with Humana. My rheumatologist is not in the network, and I really can't afford to pay the extra $500 deductible to see her. I just don't want to be so limited in what doctors I can see or have to keep switching doctors when they decide to leave the network. So I'm sticking with original Medicare and the separate Rx plan.

Thanks again for the input and advice. I feel much more at ease now with this decision. At least I know Medicare is reliable and I can keep seeing all my favorite doctors. :yes:

 

[emu]

Do you live in or near a large city? We have two local hospital networks that have plans that cover parts A and B here. The coverage is free. Copays to see a PCP are $25.00 and copays to see a specialist are $35.00. Like I said, my outpatient surgery was free. My pain management doctor and rheumy are on the plan even though they are not employed by that hospital. They contract out some doctors.

My PCP is not on the plan. I did pay for a regular appointment to see him last year but I'm still paying for that appt.

They also cover Rx up to $1500 and then you're on your own until you reach something like $4500.

I found out about these plans through my local AARP who will help you if you are disabled.