Humana Enhanced is a 2018 prescription drug plan (PDP) that's available to people in Rhode Island with Medicare benefits.
Be sure to have a look at the five most important components of the Humana Enhanced plan before finalizing your enrollment decision:
- Premium & Deductible: The premium is the amount you pay to be in the plan. This is the monthly cost of membership. In addition, plans may have an annual deductible. This is an amount that you pay towards your prescription costs before cost sharing begins.
- Co-pays & Co-insurance: This is where many people pay more than they should. Prescription co-payments (what you pay at the pharmacy) vary widely based on the formulary tier your drug is in. It's critical to verify that your medications are covered at the lowest tier possible.
- Coverage Phases: All Medicare Part D plans have an initial coverage phase, followed by a coverage gap phase, followed by a catastrophic coverage phase. The phase you're in will largely depend on the cost of your prescriptions. Some plans offer additional coverage in the gap phase. If you have costly medications, look for a plan with additional gap coverage.
- Medication Cost: One of the most challenging aspects of the Medicare Part D program is finding your prescription at the best price. It has as much to do with the pharmacy you use as it does the plan itself. This is because plans have preferred pharmacies and pharmacies have different contracts with pharmaceutical manufactures. Here's a secret, use our friends at GoodRx.com to find your prescription at the best price in your town.
- 5-Star Ratings: Critical measurements, by Medicare, will help you see how well this plan will care for you.
Detailed Cost Information
The Humana Enhanced plan does not cover all of your prescription costs. The costs are shared. Your costs includes the monthly premium, an annual deductible (if applicable), and co-payments and/or co-insurance when you pickup your prescriptions.
The annual premium is $886.80 ($73.90 paid monthly). It breaks down as follows:
You can't join the Humana Enhanced plan if you have low income subsidy (LIS) benefits.
This plan has a $0.00 deductible (annual).
A zero dollar ($0.00) deductible, like this plan has, gives you first dollar coverage. Some PDPs have a deductible (up to $400 per year in 2018) that you must pay out-of-pocket before coverage begins.
Your Out-of-Pocket Costs: Premium + Deductible + Co-pay
You are required to pay your premium each month, even if you don't fill a prescription. Plus, you'll pay all of your prescription costs until the annual deductible amount has been paid (if any). You'll also pay the required copayment at your pharmacy when you have your prescriptions filled. These are your costs and the plan pays the rest.
Your Costs May Be Different
Most people pay the standard premium. However, if you get Extra Help from Social Security, due to your income, your premium will be less. That's one situation. The other is a penalty for not enrolling on-time. In this case, Medicare can impose a penalty and your premium will be higher.
Details of Plan Coverage
Humana Enhanced is a Enhanced Alternative plan. By law, Humana Insurance Company is required to offer a standard benefit package. The standard benefit has an annual deductible, an initial coverage limit, a gap in coverage (donut hole), and a catastrophic coverage phase. Insurance carriers have the option to offer plans that:
- are an actuarial equivalent to the standard benefit; or
- provide enhanced benefits, as compared to the standard benefit.
Most enhanced plans provide additional coverage in the coverage gap phase. If your medications are costly, shop and compare enhanced plans.
Initial Coverage Limit Phase
It's important to understand the initial coverage limit (ICL) and how it applies to you in Rhode Island. The ICL is where you share the cost of your prescriptions with the insurance company. You and Humana Insurance Company each pay your share until you reach a total of $3750.00 spent at the pharmacy on prescriptions. At that point you pay all costs yourself because you're in the coverage gap, as explained below.
Coverage Gap Phase
If you reach the coverage gap phase, or donut hole, as many people call it, you are essentially uninsured and must pay for all of your prescription costs out-of-pocket. When you reach the coverage gap with the Humana Enhanced plan will all depend on your prescriptions. Most people never exceed the ICL and don't have to worry about it. If you are on a long-term medication that's costly, you could reach the donut hole very quickly.
If you reach the ICL (most seniors don't), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $4,550 (excluding your monthly premiums and the amount paid by the plan). This is called the coverage gap or donut hole. The good news is that you get a 47.5% discount on brand-name prescription drugs and a 28% discount on generic drugs while you're in the gap. You get to the other side of the donut hole when you've spent $4,550, at which point you automatically qualify to receive catastrophic coverage from Medicare.
Enhanced Gap Coverage
Humana Enhanced has limited coverage in the gap coverage phase. Call or review the plan's Summary of Benefits for additional information. If you went into the coverage gap phase last year, and could not afford your medications, call with your local Rhode Island Medicaid office and the Social Security Administration (SSA). The SSA's Extra Help program helps people who can't pay for their prescriptions.
Catastrophic Coverage Phase
Once you've spent $4,950 out-of-pocket in 2018, you're out of the coverage gap phase. At this point, you automatically get "catastrophic coverage." This assures that you'll only pay a small co-insurance or co-payment for covered drugs for the remainder of the year.
Co-payment & Co-insurance Details
In addition to the monthly premium and annual deductible, the Humana Enhanced prescription drug plan has co-payments (fixed dollar amount) and/or co-insurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
|Tier||You Pay||Tier Description|
CRITICAL: To understand how much you will pay at the pharmacy if you join this plan, you must find the tier of each of your prescriptions in the plan's formulary.
TIP: Use the GoodRx Medicare tools to find your prescription at the best price in your town.
CMS 5-Star Ratings
The annual CMS plan ratings are important. Each year CMS rates PDPs across four categories. Ratings offer a good clue as to the quality of service you can expect if you join the plan.
|2018 Overall Rating|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Humana Insurance Company Contact Information
Here's the new member contact information for Humana Insurance Company:
For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the Humana Enhanced prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Cranston, Providence, Warwick, Pawtucket, Woonsocket, Coventry, and all other towns and cities in Rhode Island.
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