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Is Medicare and Humana the same thing? Do they both have the same benefits? Does Humana pay more for medication than Medicare?

Category: Medicare Plan Providers
Updated: Jul, 26 2023

No 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

Retail Cost You Pay Your Medicare
drug plan pays
Mfgr. pays
Amount counting
toward your TrOOP
Initial Deductible $100 $100 $0 $0 $0 $100
Initial Coverage Phase * $100 $25 $75 $0 $0 $25
Coverage Gap - brand-name ** $100 $25 $5 $70 $0 $95
Coverage Gap - generic *** $100 $25 $75 $0 $0 $25
Catastrophic Coverage (brand drug) **** $200 $10 $30 $0 $160 n/a
Catastrophic Coverage (generic drug) **** $100 $5 $15 $0 $80 n/a

* 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.

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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
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