HumanaOne – HSA vs PPO Insurance Plan Comparison


HumanaOne Illinois Dental Plan insurance
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Question HumanaOne Individual Health Plan HumanaOne HSA-Qualified, High Deductible Health Plan
What are my HumanaOne plan choices? The traditional HumanaOne  Individual Health Plan is a Preferred Provider Organization (PPO) plan. The HumanaOne HSA-Qualified plan is a specially designed high-deductible Preferred Provider Organization (PPO) plan. When you enroll in this type of plan, you have the option to contribute to a personal, tax-free Health Savings Account (HSA).
What’s the deductible? Depending on the state you live in, HumanaOne Individual Health Plans are typically available with annual deductibles of:

  • Single coverage – $500; $1,000; $2,500; $5,000
  • Family coverage – $1,500; 3,000; $5,000; $10,000

Deductibles listed are for participating providers; there is a separate deductible for nonparticipating providers. Get a quote to see what’s available in your area.

Depending on the state you live in, HumanaOne HSA plans are typically available with annual deductibles of:

  • Single coverage – $1,500; $2,000; $2,600; $5,000
  • Family coverage – $3,000; $4,000; $5,150; $10,000

For qualified medical expenses, you may use tax-free HSA funds to meet your deductible. Deductibles listed are for participating providers; there is a separate deductible for nonparticipating providers. Get a quote to see what’s available in your area.

For family coverage, is there a separate deductible for each individual, as well? Yes, each family member has a separate deductible. However, the family deductible is two or three times the individual deductible – so if four or more family members are covered, only two or three may have to meet the separate individual deductible to satisfy the family deductible, too. No, the family deductible applies to all covered family members, so one person’s covered expenses could satisfy the deductible for the entire family.
What happens after I meet the deductible? The plan pays coinsurance for covered medical expenses as shown on the Benefits Sheet. The coinsurance percentage varies depending on the service you receive. (Coinsurance may vary in your area due to state regulations.) The plan pays coinsurance for covered medical expenses as shown on the Benefits Sheet. You can use HSA funds to pay your share, if any. Humana offers two coinsurance options: an 80/60 plan and a 100/70 plan. With the 100/70 plan, the plan pays 100 percent of your costs for common services like doctor’s office visits when you use participating providers. (Coinsurance may vary in your area due to state regulations.)
Do I have copayments? Yes, some services require copayments. Also, you may have the opportunity to purchase the office visit copayment benefit; with this option, you pay a copayment for certain kinds of doctor’s office visits (illness or injury, not preventive care), and then your plan covers the rest of the cost. No, the plan doesn’t have copayments.
Do copayments help reduce my deductible? No, medical and prescription drug copayments do not apply to your deductible or out-of-pocket maximum. Not applicable.
Is there a limit on how much I’d pay in a year? Yes, the plan has separate out-of-pocket expense limits for participating and nonparticipating providers. Once you reach the limit for participating providers, the plan pays 100 percent for covered services. However, copayments and some other costs don’t apply to the limit. Approved mental health services are subject to a separate benefit level. Yes, the plan has separate out-of-pocket expense limits for participating and nonparticipating providers. With the 100/70 coinsurance plan, the participating provider limit is the same as the deductible – so once you reach your deductible, the plan pays 100 percent for covered services (approved mental health services are covered at 50 percent). Approved mental health services are subject to a separate benefit level.
How are prescription drugs covered? You pay the entire bill for prescriptions until you meet a separate Rx deductible. However, as a Humana member you get a discounted price when you use participating pharmacies. Once you meet the Rx deductible, you pay only a copayment for covered drugs. Drugs are assigned to one of four levels, and the copayment varies by level. You may have the option to purchase a zero deductible prescription drug benefit. When you fill prescriptions for drugs on Humana’s Drug List, the cost applies to your medical deductible. As a Humana member, you pay a discounted price when you use participating pharmacies. Then, once you meet the deductible with any combination of medical and prescription drug costs, your plan pays coinsurance as specified in your plan. With Humana’s 100/70 coinsurance plan, the plan pays 100 percent for covered drugs, and you pay nothing.
Are dental expenses covered? No, unless the service is related to an injury. A separate dental plan is available as an optional benefit. No, unless the service is related to an injury. A separate dental plan is available as an optional benefit.