Medicare and Humana are not the same.
Humana is one of the largest private 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 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.
In the Catastrophic Coverage
stage of your Medicare Part D plan, 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 is the last year that Medicare Part D
beneficiaries will pay cost-sharing in the Catastrophic Coverage phase.
For plan year 2024
, the Inflation Reduction Act (IRA) of 2022
eliminates beneficiary cost-sharing in the Catastrophic Coverage phase.
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).
When you purchase a formulary medication
with a $100 ($200) retail cost in 2023
drug plan pays
toward your TrOOP
|Initial Coverage Phase *
|Coverage Gap - brand-name **
|Coverage Gap - generic ***
|Catastrophic Coverage (brand drug) ****
|Catastrophic Coverage (generic drug) ****
* 25% co-pay 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).
Need some help planning your spending throughout the phases of your Medicare drug coverage?
To help you visualize the phases of your Medicare Part D prescription drug plan coverage, we have a Donut Hole Calculator or PDP-Planner
online illustrating the changes in your monthly estimated costs based on the established annual standard Medicare Part D plan limits mentioned above.
Changes are coming. Read more in our article:
2022 Inflation Reduction Act (IRA): Changes to Medicare Part D prescription drug coverage 2023 and beyond.