Humana’s HMO push for 2010
October 2009: Humana is making a big push for its Medicare HMO and PPO plans for 2010. The Tucson office now has ten captive agents covering souther Arizona and the company is advertising heavily on television to promote its plans.
Humana’s enrollment numbers for its Medicare Advantage plans total about 1,500 in Pima County. This is far behind Secure Horizons’ 30,000-plus enrollees and Health Net’s 20,000.
People on Medicare can change their Medicare coverage from November 15 to December 31, and the change becomes effective on January 1, 2010.
Humana has spent three years building their doctor and hospital networks in Pima County, and their Medicare Advantage plans may offer strong competition to Secure Horizons and Health Net this year.
Humana will offer the only local or regional PPO (Preferred Provider Organization) in 2010, as Health Net is cancelling its Violet PPO plan. A PPO has a network of doctors, but allows members to go out-of-network for a higher co-payment. PPO plans do not require referrals, which are mandatory in most HMO’s (Health Maintenance Organization).
Humana is introducing some out-of-network options for its HMO plans by allowing its members to use out-of-network hospitals across the country for the same co-payments they would pay in Tucson. This is one way to overcome objections some seniors have to the limitations of local HMO networks.
Humana enrolled thousands of seniors into their PFFS (Private-fee-for-Service) plans in 2006 and 2007. But these plans, with no doctor networks, have proven to be expensive and unpopular with lawmakers in Washington, DC. Humana raised premiums in 2007, 2008 and 2009, and lost most enrollees in their PFFS plans when the monthly cost went over $90 this year. Instead of cancelling these PFFS plans, Humana raised the plan premiums to discourage people from staying in them.
Seniors who are thinking about changing their Medicare coverage, or switching Medicare Advantage plans can compare plans on http://medicare.gov web site, or they can talk to an independent insurance agent who represents several plans. The most popular plans in Pima County are Secure Horizons, Health Net, and Humana.
Most Medicare Advantage plans in Pima County are HMO’s which have doctor and hospital networks and require referrals to see specialists. HMO’s were designed to save Medicare money by controlling costs through managed care.