No Medicare and Humana are not the same.

Humana, Inc. is one of the largest insurance companies that provides, along with other products, Medicare Advantage plans and Medicare Part D prescription drug plans.  Humana is contracted with the federal government to provide and administer these Medicare plans under the Medicare program. To learn more about Humana, you can visit the Humana website at www.Humana.com.

In comparison, Medicare is a federal program started in 1965 by President Johnson to provide health care for seniors citizens (over 65) and people receiving disability benefits.

Medicare is operated by the Centers for Medicare and Medicaid Services (https://www.CMS.gov) under the US Department of Health and Human Services (https://www.HHS.gov).

More about Medicare Part A, B, C, and D
Medicare coverage includes Medicare Part A (in-patient or hospitalization insurance), Medicare Part B (out-patient and doctor visits), Medicare Part C (Medicare Advantage plans), and Medicare Part D (prescription drug plans or PDPs).

Medicare does not directly implement these last two programs (Medicare Part C and Medicare Part D) and instead contracts with private firms or insurance carriers (such as Humana) for the purposes of implementation - and these companies must adhere to the guidance and regulations established by CMS.

Coverage of In-patient vs. Out-patient prescriptions
Some prescription medication is covered directly under Medicare Part A (in-patient drugs) and Medicare Part B (such as physician administered drugs), but the Medicare Part D program was really designed to provide self-administered, out-patient prescription drug coverage for seniors and other Medicare beneficiaries.

Usually Medicare Part A or Medicare Part B would not both cover the same medications as a private Medicare Part D plan.

However, please note:  If you have VA benefits, and you have prescriptions that are available from both the VA and your Medicare Part D plan, you will be able to choose either your Medicare Part D plan or the VA as the source for some of your medications, depending on the cost.

Since not all prescriptions drugs are covered by a Medicare Part D plan and you will need to refer to your current Medicare Part D formulary or drug list for an overview of the covered medications and the cost-sharing for the covered medications.

You can review any Medicare prescription drug plan formulary at our site: FormularyBrowser.com.

In summary, if you have a Humana Medicare Part D prescription drug plan, then you will have your formulary covered out-patient prescription medications covered by the plan (after meeting the deductible).  However, a Medicare Part D plan can change the cost you will pay for a covered prescription drug from year-to-year and you will need to review the details of the current Medicare plan to see the costs of drug coverage.  You can see yearly cost and coverage changes using our Medicare Part D comparison tool:  PDP-Compare.com.


Question:  Who actually pays for my Part D medications?

Depending on your phase of Part D coverage, a portion of your medication cost coverage is paid by you, the Medicare plan, the drug manufacturer for brand-name drugs, and/or the federal government (Medicare) - assuming your medications are on the Medicare Part D plan's drug list or formulary.  If your Medicare Part D plan has an initial deductible, you will pay 100% of the formulary drug costs, unless your low-cost drugs are exempt from the deductible.

Even though it is now considered "closed", if you enter the Donut Hole or Coverage Gap portion of your drug plan, you and your Medicare plan will share in the cost of your generic drugs and brand-name drug purchases will be split between you, your Medicare plan - and the largest portion (70%) of your covered brand-name prescription costs purchased while in the Donut Hole or Coverage Gap are paid by the pharmaceutical manufacturer.

Important:  Starting in 2025, the Inflation Reduction Act (IRA) eliminates the Coverage Gap (Donut Hole).  In 2025 and beyond, Medicare Part D beneficiaries will stay in the Initial Coverage phase until their out-of-pocket spending for Part D formulary drugs (TrOOP) reaches the maximum out-of-pocket spending limit for Part D formulary drugs (RxMOOP) - which is set at $2,000 for 2025.  After reaching RxMOOP, Medicare Part D beneficiaries will enter Catastrophic Coverage and have a $0 copay (no additional costs) for all formulary Medicare Part D drugs through the remainder of the year.

In the Catastrophic Coverage phase of your Medicare Part D coverage, the federal government pays more for your medication costs (reimbursing the Medicare drug plan for a large portion of the Catastrophic Coverage cost).  Keep in mind that 2023 was the last year that Medicare Part D beneficiaries paid cost-sharing in the Catastrophic Coverage phase. 

Important:  Starting with plan year 2024, the Inflation Reduction Act (IRA) eliminated beneficiary cost-sharing in the Catastrophic Coverage phase.  This means, if you exit the 2024 Donut Hole and enter the Catastrophic Coverage phase, you will pay nothing more (cost-sharing will be $0) for all formulary Medicare Part D drugs through the remainder of the year.

You can read more about upcoming Part D drug plan changes in our article:
2022 Inflation Reduction Act (IRA): Changes to Medicare Part D prescription drug coverage 2023 and beyond.

Who paid in 2023?

The chart below shows how example formulary drug purchases are calculated throughout your Medicare Part D plan (using the CMS defined standard benefit Medicare Part D plan with a fixed 25% cost-sharing as a guide).


* 25% copay or cost-sharing
** 75% Brand-name Discount
*** 75% Generic Discount
**** In 2023, you pay the higher of 5% of retail or $10.35 for brand drugs and the higher of $4.15 for generic or multi-source drugs (80% paid by Medicare, 15% paid by Medicare plan, and around 5% by plan member).


Who pays in 2024?

Below is a chart showing example formulary drug purchases are paid throughout your Medicare Part D plan coverage -- using the CMS defined standard benefit Medicare Part D plan with a fixed 25% coinsurance for calculating cost-sharing.




* 25% copay or cost-sharing
** 75% Brand-name Discount
*** 75% Generic Discount
**** In 2024, the Catastrophic Coverage phase will still exist, but a plan member will not have any out-of-pocket costs for formulary drugs after reaching the plan's $8,000 total out-of-pocket threshold (TrOOP) becomes the RxMOOP threshold.


Who pays in 2025?

Starting in 2025, the IRA again change the percentage of the drug costs allocated to the brand-name drug manufacturer, Medicare Part D plan, and the federal government.



* 25% copay or cost-sharing until you reach the $2,000 RxMOOP, then your Part D formulary drug costs are $0 for the remainder of the year.
** The 10% brand-name drug manufacturer discount applied in the 2025 Initial Coverage Phase (after the standard deductible) does not apply toward the $2,000 TrOOP threshold or RxMOOP threshold. (https://www.cms.gov/files/document/manufacturer-discount-program-final-guidance.pdf).
**** Starting in 2025, the Coverage Gap (or Donut Hole) will no longer exist for plan members.  A plan member will stay in the Initial Coverage phase until exceeding the plan's $2,000 out-of-pocket spending threshold and enter Catastrophic Coverage where for the remainder of the year, the person will not have any out-of-pocket costs for formulary drugs.

Question:  Can the $2,000 RxMOOP threshold for 2025 and beyond change every year?

Yes.  Like other Medicare Part D plan parameters, the annual $2,000 RxMOOP can (and probably will) change every year.  Currently, the Catastrophic Coverage threshold (or RxMOOP) is predicted to decrease over time (https://www.cms.gov/oact/tr/2023).

Year	Catastrophic threshold (RxMOOP)
2024	$8,000
2025	$2,000
2026	$2,000
2027	$1,950
2028	$1,850
2029	$1,800