Medicare Eligibility: Humana Medicare Advantage Guide

Getting Medicare right can save you thousands and improve your care.

This guide explains who’s eligible, what each part covers, how the Medicare Part B premium and Part D work, and where Humana Medicare Advantage and other Medicare Advantage plans may fit.

Who Is Eligible for Medicare?

Age 65+: Most people qualify at 65 if they’re U.S. citizens or permanent legal residents (generally 5+ continuous years). If you’ve worked and paid Medicare taxes long enough, Part A is usually premium-free; others can buy in.

Under 65 with certain conditions: You may qualify after 24 months of Social Security Disability Insurance (SSDI), or immediately with ALS (Lou Gehrig’s disease). People with End-Stage Renal Disease (ESRD) can qualify based on dialysis or a kidney transplant. Your Initial Enrollment Period (IEP) runs seven months—three before your 65th birthday month, your birthday month, and three after.

Enrollment windows matter: Miss your IEP and you may need the General Enrollment Period (GEP) from Jan 1–Mar 31, with coverage starting soon after enrollment; late penalties may apply. You can also get a Special Enrollment Period (SEP) if you delayed Part B due to active employer coverage or you move, lose coverage, or experience other qualifying life events.

What Each Part Covers (A, B, C, and D)

Part A: Hospital insurance

Part A helps cover inpatient hospital care, skilled nursing facility care (after a qualifying hospital stay), some home health, and hospice. There’s a deductible and daily copays for longer stays. Most people don’t pay a premium for Part A if they or a spouse worked enough quarters.

Medicare Part B: Medical insurance

Part B covers doctor visits, outpatient care, preventive services, lab work, durable medical equipment, and many vaccines. You generally pay a monthly Medicare Part B premium that’s set annually; higher-income beneficiaries may pay more due to IRMAA. There’s also an annual Part B deductible and typically 20% coinsurance for most services after the deductible, with no out-of-pocket maximum under Original Medicare unless you add a Medigap plan.

Avoiding penalties: If you don’t enroll in Medicare Part B when first eligible and lack creditable employer coverage, you can face a permanent late enrollment penalty added to your Part B premium. Confirm with your HR or plan whether your coverage is considered “creditable.”

Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers and bundle Part A and Part B, often including Part D drug coverage and extra benefits like dental, vision, hearing, fitness, and care coordination. These plans have provider networks (HMO, PPO) and an annual maximum out-of-pocket limit for Part A and B services, which Original Medicare lacks. Many people consider Humana Medicare Advantage options for their supplemental benefits, care teams, and national footprint—availability and specifics vary by county.

Medicare Part D: Prescription drug coverage

Part D is offered by private plans that cover prescription drugs. Costs depend on the plan’s premium, deductible, and formulary tiers. Like Part B, enrolling late without creditable drug coverage can trigger a lifelong penalty. Review each plan’s formulary to make sure your medications are covered affordably.

Costs and Ways to Save

Medicare costs differ by part and by plan choice. Here are key cost levers to understand:

Medicare Part B premium: Standard premium amounts are set each year; higher earners may owe IRMAA. Budget for the premium plus the Part B deductible and 20% coinsurance for most services.
Part D costs: Monthly premium, deductible, copays/coinsurance by formulary tier, and potential IRMAA for higher incomes.
Medicare Advantage: You still pay the Part B premium in most cases, and possibly an additional plan premium (some plans are $0). Evaluate copays, coinsurance, and the plan’s annual out-of-pocket maximum.
Medigap (for Original Medicare): A separate premium for standardized supplemental coverage that helps pay Part A and B costs; Medigap generally doesn’t include Part D.

Programs that can help:

Extra Help (Low-Income Subsidy) can dramatically reduce Part D premiums and drug costs if you qualify.
Medicare Savings Programs (MSPs) may pay some or all of your Part B premium and reduce other costs for those with limited income/resources.
Employer/union or VA/TRICARE coverage may coordinate with Medicare—confirm which is primary and whether your drug coverage is creditable to avoid penalties.

Original Medicare vs. Medicare Advantage: Which Fits You?

There’s no one-size-fits-all answer—consider your providers, prescriptions, travel needs, and budget.

Keep any doctor who accepts Medicare: Original Medicare + optional Part D + optional Medigap offers broad access, predictable cost-sharing with Medigap, and no networks—but charges separate premiums.
All-in-one simplicity and extras: Medicare Advantage plans (including Humana Medicare options) package A and B and often D, add benefits like dental/vision/hearing, and cap medical out-of-pocket costs—but use networks and may require referrals/prior authorizations.
Travel and snowbirds: Frequent travelers may prefer Original Medicare’s nationwide acceptance; some PPO Medicare Advantage plans offer broader networks or out-of-network coverage at higher cost.

Tip: Nearly half of Medicare beneficiaries now enroll in Medicare Advantage, often for the simplicity and added benefits. Still, the best fit depends on your doctors, drugs, and comfort with networks.

How to Choose a Plan (Including Humana Medicare Options)

Use this step-by-step approach to compare choices in your county:

List your providers and medications. Check whether your doctors are in-network for the Medicare Advantage plans you’re considering and confirm drug formulary coverage (dosage, quantity limits, and prior authorizations).
Estimate total annual costs. Add premiums + expected copays/coinsurance + deductibles + the Part B premium. For Medigap, include the Medigap and Part D premiums.
Check plan star ratings and benefits. Look at quality ratings, care coordination services, telehealth, dental/vision/hearing allowances, and fitness or over-the-counter benefits.
Consider Humana Medicare Advantage and other carriers side by side. Evaluate HMO vs. PPO networks, specialist access, and any chronic condition special needs plans (C-SNPs) if applicable.
Review protections and limits. Note the Medicare Advantage annual out-of-pocket maximum for Part A and B services and any tiered provider costs in PPOs.
Confirm subsidies. See if you qualify for Extra Help or an MSP to lower your Medicare Part B premium and drug costs.

Enrollment Timeline at a Glance

Initial Enrollment Period (IEP): 7 months around your 65th birthday.
General Enrollment Period (GEP): Jan 1–Mar 31 if you missed IEP (late penalties may apply).
Annual Enrollment Period (AEP): Oct 15–Dec 7 to join, switch, or drop Medicare Advantage or Part D for Jan 1 coverage.
Medicare Advantage Open Enrollment (OEP): Jan 1–Mar 31 to switch Medicare Advantage plans or return to Original Medicare (one change).
Special Enrollment Periods (SEPs): For moves, plan terminations, qualifying life events, or when you gain/lose Medicaid/Extra Help.

A Quick Example

Maria is 67, sees two specialists, and takes three generic prescriptions. She compares Original Medicare + Medigap + Part D versus a local PPO Medicare Advantage plan from a national carrier like Humana Medicare Advantage. The PPO offers her doctors in-network, $0 telehealth, and a dental allowance, plus a capped medical out-of-pocket limit. After tallying premiums and expected copays, the Medicare Advantage plan’s total estimated annual cost is slightly lower than Medigap for her situation—so she enrolls during AEP. Your costs could differ based on providers, drugs, and travel habits.

Key Takeaways

Most people become eligible for Medicare at 65; others qualify earlier through disability, ALS, or ESRD.
Understand the roles of Part A, Medicare Part B, and Medicare Part D before comparing plans.
Account for the Medicare Part B premium and potential IRMAA; avoid late enrollment penalties for B and D.
Medicare Advantage plans (including Humana Medicare Advantage) can add benefits and cap medical costs, but use networks.
Use star ratings, formularies, and total cost estimates—not just premiums—to choose wisely.
Check eligibility for Extra Help and Medicare Savings Programs to reduce premiums and copays.

Final tip: Plan details and costs change annually. Review your coverage every fall during AEP to keep your care and budget on track.