Exploring Humana Medicare Advantage Plans in Virginia

Humana offers a variety of Medicare Advantage plans in Virginia, providing options that cater to different needs and preferences. These plans, offered by Medicare-approved private companies, bundle Part A, Part B, and usually Part D coverage into one plan, with additional benefits not covered by Original Medicare.
Whether you prefer the cost-effectiveness of utilizing in-network providers or the flexibility to seek services outside the network, Humana has a plan designed for you.
The types of Medicare Advantage plans provided by Humana in Virginia include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-for-Service (PFFS) options.
Each plan type offers a unique blend of coverage, cost, and flexibility, allowing you to find a plan that fits your health needs and budget. We will now examine each of these plan types in detail.
Medicare Advantage HMO Plans
Humana Medicare Advantage HMO plans emphasize the use of in-network providers to ensure members receive the highest level of benefits. These plans are designed with cost-effectiveness in mind, as members who utilize in-network providers typically experience lower out-of-pocket costs as compared to out-of-network services or Medicare Advantage HMO PPO options.
Moreover, staying within the Humana HMO network means members can avoid the additional step of obtaining prior authorizations for certain services. This simplicity and cost-effectiveness make HMO plans a popular choice among Humana’s Medicare Advantage members in Virginia.
Medicare Advantage PPO Plans
Humana Medicare Advantage PPO plans in Virginia offer:
- A broad coverage area, allowing beneficiaries the flexibility to choose healthcare providers both within and outside the Humana network
- The freedom to choose healthcare providers, giving members a wider range of options
- The ability to seek services from specialists without needing a referral
While enrollees may receive care from out-of-network providers, the cost may be higher compared to services rendered by in-network providers. However, PPO plans come with various benefits, such as home healthcare services, telehealth appointments, and customizable plan options geared to individual health needs.
Choosing an out-of-network provider can lead to higher out-of-pocket costs, but Humana PPO plans to extend the choice of providers for an increased cost.
Medicare Advantage PFFS Plans
Private Fee-for-Service (PFFS) is a type of Medicare Advantage Plan that provides greater flexibility in choosing Medicare-approved healthcare providers. As a PFFS organization, Humana offers Medicare Advantage PFFS plans in Virginia, allowing members to see any Medicare-approved healthcare provider who accepts the plan’s payment terms.
In PFFS plans:
- No referral is needed to see specialists, providing greater flexibility to beneficiaries in managing their healthcare.
- However, healthcare providers can decide on a case-by-case basis whether to accept a PFFS plan, which may change each time services are provided.
- PFFS members may need to pay a monthly premium in addition to the Medicare Part B premium, and costs can vary based on the services used.
Out-of-pocket expenses may be higher if a member sees providers that do not accept the plan terms or go out-of-network in non-emergency situations.
Understanding Your Medicare Contract

While exploring plan options is important, understanding your Medicare contract is paramount. When signing up for Medicare coverage during enrollment periods, beneficiaries must choose how to receive health coverage, including the Original Medicare component, which includes Part A (Hospital Insurance) and Part B (Medical Insurance).
In Original Medicare, beneficiaries may have the following options and benefits:
- Pay a share of the costs as they receive services, with no out-of-pocket expense limit unless they have additional coverage like Medigap or Medicaid.
- Medicare covers medically necessary services as well as many preventive services, often at a lower cost if provided by doctors or facilities that accept the Medicare-approved amount.
- Beneficiaries have the flexibility to visit any doctor or hospital that accepts Medicare.
- They can join a separate Medicare drug plan for prescription coverage.
- They have the option to purchase a Medigap policy to assist with lowering out-of-pocket costs.
Contract Renewal
A key aspect of your Medicare contract with Humana is the yearly contract renewal. Enrollment in Humana plans, including both availability and associated costs, is subject to yearly contract renewals. For Humana Medicare Advantage PFFS plans in Virginia, continued enrollment is contingent on an annual contract renewal with CMS.
Keeping abreast of contract renewals is necessary as they can impact your plan options and premiums year after year. This ensures that you make the most out of your Medicare Advantage plan while keeping up with any changes that may affect your healthcare needs.
Dual Eligible Special Needs Plans
An additional important factor to consider is the Dual Eligible Special Needs Plans (D-SNPs). These plans are specifically designed to serve individuals who qualify for both Medicare and Medicaid, offering coordinated health coverage.
To enroll in D-SNPs, individuals must be entitled to Medicare (Title XVIII) and receive medical assistance from a state plan under Medicaid (Title XIX).
However, eligibility criteria for D-SNPs vary by state since states have discretion in determining their specific Medicaid eligibility categories. This affects who can enroll in these plans, making it important to understand your individual eligibility status.