Top 5 Largest Health Insurance Companies for 2024

Every major largest health insurance companies serves millions of clients. Accessing health insurance from these major providers can be achieved through various channels. For instance, you can opt for largest health insurance via your employer’s benefit program, or you have the option to purchase a private insurance plan through the Affordable Care Act (ACA) marketplace, often referred to as “Obamacare.”

Largest health insurance companies by revenue

CompanyMarket shareRevenue (billions)
UnitedHealth Group15%$189
Elevance Health (Anthem)10%$124
Kaiser Permanente9%$114
Centene (Ambetter)9%$110
Humana7%$86

1. UnitedHealth Group

UnitedHealthcare provides diverse Medicare Advantage options that encompass a broad spectrum of advantages, frequently without any cost for premiums, copayments, or deductibles. The plans are ideal for individuals seeking comprehensive coverage options, a wide variety of plan alternatives, and affordable monthly payments.

Largest health insurance companies - UnitedHealth Group

Key feature

  • Certain plans come with no premiums, copays, or deductibles to pay.
  • Some plans provide benefits for vision, dental, and hearing care.
  • Access a network of 1.3 million healthcare professionals nationwide.

Established in 1977 and based in Minnetonka, Minnesota, UnitedHealthcare stands as the leading health insurance company in the United States. Apart from Medicare Advantage plans, UnitedHealthcare presents a diverse range of insurance options including Medicare Supplement plans, Medicaid benefits, individual health insurance plans, short-term health insurance policies, small business health insurance plans, and independent dental coverage. Through its assortment of plans, UnitedHealthcare caters to nearly a third of all individuals within the Medicare program, solidifying its position as the largest Medicare Advantage plans provider in the nation.

Pros and cons

Pros

  • Great Ratings: UnitedHealthcare’s Medicare Advantage plans score an impressive average of 4.2 out of 5 stars from the Centers for Medicare and Medicaid Services (CMS), just a notch below Blue Cross Blue Shield, the only nationwide insurer with a higher star rating.
  • Extra Coverage: Many plans by UnitedHealthcare offer added coverage, especially during the donut hole phase, making them an excellent choice for those with significant medication needs. This feature helped UnitedHealthcare secure top positions in our lists of the Best Medicare Advantage Plans and the Best Medicare Part D Plans.
  • Affordable Supplement Plans: UnitedHealthcare provides competitively priced Medigap plans, particularly standing out in terms of pricing. For instance, in Texas and Florida, the average monthly cost for Plan G was an affordable $184.
  • Extensive Provider Network: Being the leading provider of Medicare Advantage plans, UnitedHealthcare boasts the largest national network of healthcare providers among major insurers.

Cons

  • Mediocre J.D. Power Score: UnitedHealthcare ranked fourth in the J.D. Power 2022 U.S. Medicare Advantage Study, scoring just below the industry average. Some companies scored better, while others scored worse.
  • Not the Cheapest Medicare Advantage Plans: UHC’s Medicare Advantage plans for 2023 have a maximum out-of-pocket limit, averaging at $5,299.47, in line with major insurers like Blue Cross Blue Shield and Cigna. The average drug deductible is also in the middle range. While not a major drawback, there are plans available from other companies that have lower overall costs.

UnitedHealthcare Medicare Advantage Plans at a Glance

  • Plan choices: UnitedHealthcare offers different types of plans for Medicare Advantage customers, including HMO, PPO, and SNPs.
  • Many providers: UnitedHealthcare has a vast network of healthcare providers, with 1.3 million professionals and 6,700 hospitals and care centers.
  • Premiums: Around 6.5 million members don’t have to pay a monthly premium for their Medicare Advantage plans with UnitedHealthcare.

How UnitedHealthcare Medicare Advantage Plans Operate

UnitedHealthcare provides a range of Medicare Advantage plans, often in collaboration with AARP, catering to about 9 million individuals. Membership with AARP is not a prerequisite for enrollment in these plans. Availability and costs of plans may vary by state.

Types of UnitedHealthcare Plans:

  • Medicare Advantage HMO Plans: Low copays, premiums, and coinsurance, with the freedom to choose any in-network UnitedHealthcare provider.
  • Medicare Advantage PPO Plans: Lower out-of-pocket expenses with in-network providers, but flexibility to use any provider accepting their insurance (at a higher cost).
  • Medicare Advantage Special Needs Plan (SNPs): Tailored for individuals enrolled in both Medicare and Medicaid, residing in long-term care facilities, or having specific chronic conditions.

Additional Benefits Depending on the Chosen Plan:

  • Prescription Drug Coverage: $0 copays and deductibles for Tier 1 and Tier 2 prescription drugs, with an extensive network of national and local pharmacies.
  • Dental, Vision, and Hearing Care: Comprehensive coverage for preventative dental care, annual eye exams, frames, contact lenses, hearing exams, and discounts on hearing aids, often with $0 copays.
  • Over-the-Counter Product Credits: Assistance in covering costs of over-the-counter items such as vitamins and pain relievers.
  • Fitness Perks: Some plans offer a free gym membership, personalized fitness plans, access to online workout videos, and invites to local wellness events and classes.
  • Telehealth Access: Access virtual medical care from home with no copay.
  • HouseCalls: Beneficiaries receive annual home visits from licensed clinicians for care coordination and testing for chronic conditions.
  • Navigate4Me: Tailored for Medicare Advantage holders with complex health needs, providing a single point of contact for care coordination and claims assistance.

The Cost of UnitedHealthcare Medicare Advantage Plans

The cost of a UnitedHealthcare Medicare Advantage plan varies based on several factors. Health status and location play a role, with not all plans being accessible in every area. The frequency of doctor visits and prescription needs also impacts out-of-pocket expenses, making it essential to choose a plan accordingly.

To discover a suitable UnitedHealthcare Medicare Advantage plan aligning with specific health needs and financial considerations, prospective beneficiaries can input their ZIP code on the provider’s website to explore available plans in their vicinity.

Outlined below is a price range for plans accessible in ZIP code 44236, situated outside Cleveland, Ohio.

PLANMONTHLY PREMIUMPRIMARY CARE PROVIDER COPAYSPECIALIST COPAYOUT-OF-POCKET MAXIMUMTIER 1 PRESCRIPTION DRUGS COVERAGE
AARP Medicare Advantage Plan 7 (HMO)$0$0$40$4,500$0 copay
AARP Medicare Advantage Plan 1 (HMO)$19$0$25$3,500$0 copay
AARP Medicare Advantage Flex Plan 8 (HMO)$25$0$35$4,200$0 copay
AARP Medicare Advantage Choice (PPO)$0$0$45$5,100$0 copay
AARP Medicare Advantage Patriot (PPO)$0$0$35$4,500Not included

2. Anthem

Anthem Blue Cross and Blue Shield stands out for its extensive range of affordable health insurance plans, offering abundant options. With a network covering over 90% of doctors and hospitals nationwide, it provides substantial choices for medical care. However, the company’s customer service reputation is subpar, marked by a higher claims denial rate compared to the industry average. 

Anthem Insurance

Being one of the nation’s largest insurance companies with a massive membership of 42 million spanning 14 states, Anthem insurance holds a prominent position in the healthcare landscape.

Key feature

  • Anthem, in collaboration with its network of Blue Cross Blue Shield carriers, provides sought-after Medicare Supplement plans like G, N, and F, catering to diverse healthcare needs. 
  • Their plans often encompass exercise and weight loss programs, allowing for a holistic approach to health. 
  • Additionally, Anthem offers the choice to purchase a Part D prescription plan, dental and vision coverage, enhancing the overall healthcare package. 
  • Formerly known as Anthem, the company rebranded to Elevance Health in June 2022, solidifying its position as one of the nation’s largest health insurance networks, proudly serving approximately 47 million members.

A Medicare Supplement, often called Medigap, is designed to cover the loopholes in Original Medicare. Anthem extends three of the highly sought-after Medigap plans (F, G, and N), alongside plan A, a mandatory offering as per federal regulations. However, it’s important to note that Anthem does not provide Medicare Supplement plans in all states or markets.

Anthem’s Medicare Supplement plans frequently feature SilverSneakers, granting members free access to a network of gyms. Additionally, they offer ScriptSave/WellRx, a savings program for prescription drugs that also provides discounts on weight loss programs, various vitamins, and supplements.

Pros and cons

Pros

  • Financial Stability: Anthem is a financially stable industry leader, as affirmed by reputable sources like Moody’s and AM Best.
  • Comprehensive Preventative Care: Anthem plans cover preventative care, including gym memberships, promoting a proactive approach to health.
  • User-Friendly Online Tools: Anthem provides efficient and user-friendly online tools, enhancing accessibility and ease of use for members.

Cons

  • Additional Costs for Essential Services: Dental, hearing, vision, and long-term care plans come with extra costs and are not available in all states, potentially limiting coverage for vital services.
  • Costly Medigap Plans for Low Medical Needs: Medigap plans can be expensive for individuals with minimal medical requirements, potentially posing a financial burden.
  • Varied Customer Service Reputation: Anthem holds a poor reputation for customer service in certain markets, impacting overall customer experience and satisfaction.

Anthem Medicare Supplement Plans: At a Glance

  • Plan Options: Anthem offers Medicare supplement plans A, F, G, and N. Plan N, gaining popularity, is cost-effective, while Plan G remains the most popular, covering extensive medical expenses. Plan F is available only to those eligible for Medicare before 2020.
  • Provider Network: Since most healthcare providers accept Medicare, they also accept Anthem’s supplement plans, offering broad acceptance across the country.
  • Average Monthly Premium: Anthem’s Medicare Supplement plan costs vary based on location, health needs, and the selected plan. On average, customers may pay between $102 and $226 per month, with Plan G costing approximately $231 and Plan N around $175 for a person turning 65 in 2023.

Anthem Medicare Supplement Insurance Plans

Anthem provides three main Medicare Supplement Insurance plans for any Medicare member to consider:

  • Medigap Plan A: Offers essential benefits included in every Medigap plan, providing basic coverage without additional extras.
  • Medigap Plan G: Represents the highest-coverage choice for new Medicare members, offering extensive coverage options.
  • Medigap Plan N: Features lower premiums but higher copays, making it a more cost-effective choice.

Additionally, Anthem offers Medigap Plan F for eligible beneficiaries who were qualified to enroll in Medicare before 2020. However, this plan is not available to newer Medicare members.

In certain states, such as Wisconsin, Anthem tailors their Medicare Supplement Insurance to align with state-specific standards, which may differ from the standardization used in most of the country.

Anthem allows you to enter your ZIP code on their website to explore the available Medigap plan types in your specific location.

Medicare Select Policies and Network Requirements

In specific areas, Anthem offers both standard and Medicare Select versions of certain Medigap plans. The Medicare Select policy requires you to receive non emergency services from in-network providers, offering lower premiums in return for network restrictions.

However, if you opt for a Medicare Select policy and use an out-of-network provider, you’ll be responsible for a portion of the costs that the plan would cover if you had stayed in-network.

Add-on Coverage for Dental and Vision

Anthem provides the option to add coverage with cost-sharing for services not included in standard Medigap plan types, such as dental cleanings, dental procedures, eye exams, and an allowance for glasses frames or contact lenses in certain locations.

This additional coverage requires separate premiums based on your location and the chosen coverage level.

The cost of Anthem Medicare Supplement plans varies depending on several factors. When you opt for a Medigap plan, you pay an additional premium on top of what you pay for Original Medicare. Here are the key cost considerations:

How Much Does Anthem Medicare Supplement Cost?

  • Medicare Part A and Part B Premiums: Part A may be free if you’ve contributed payroll taxes to Medicare for at least 10 years. Part B premiums vary based on age, income, and other factors, with a base monthly premium in 2023 of $164.90 per month.
  • Anthem’s Premiums: Anthem is competitive in most markets it serves but may not always be the lowest-cost carrier. They offer discounts for households with two people on an Anthem Medicare Supplement plan and for agreeing to automated electronic payments.
  • Policy Fees: In some markets, insurers may add policy fees, impacting the overall cost of the plan.
  • Prescription Drug Costs: Anthem offers good discounts on prescription drugs and provides Part D prescription drug plans. However, drug formularies change annually, so it’s essential to check medication prices each year to ensure they align with your needs.
  • Market Variability: Costs can vary based on the market and the specific plan you choose. Anthem’s prices can differ across different regions and states.

It’s crucial to assess your specific needs, compare plans, and consider factors like your location, health condition, and prescription drug requirements to determine the actual cost and value of an Anthem Medicare Supplement plan. Always review the options and costs carefully before making a decision.

3. Kaiser Permanente

Kaiser Permanente stands out as an excellent choice for health insurance, particularly if it’s accessible in your area. The health insurance plans from Kaiser Permanente have received an impressive average grade of 4.3 out of 5 from the National Committee for Quality Assurance, surpassing all other companies in our analysis. Additionally, the remarkably low level of complaints suggests a high level of customer satisfaction with their services.

Kaiser Permanente

Pros and  Cons

Kaiser Permanente Medicare Advantage plans have their own set of pros and cons:

Pros:

  • High Customer Satisfaction: Kaiser Permanente excels in customer satisfaction, earning the top spot in J.D. Power’s Medicare Advantage study, scoring 844 out of 1,000 points.
  • Outstanding Quality Ratings: Kaiser Permanente plans received exceptional ratings, with two plans obtaining a perfect 5 out of 5 from the National Committee for Quality Assurance in 2022. The 2023 plans also boast high Medicare star ratings.
  • Comprehensive Prescription Coverage: Most of Kaiser’s Medicare Advantage plans provide coverage for prescription drugs, ensuring comprehensive healthcare for members.

Cons:

  • Limited Availability: One drawback is the limited availability of Kaiser Permanente plans, only being accessible in eight states (California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and Washington state). This restricts access for the majority of U.S. adults who reside outside these areas.
  • Restricted Plan Types: Kaiser Permanente offers Health Maintenance Organization (HMO) plans exclusively. Consequently, members are confined to Kaiser’s network of medical providers, limiting flexibility in choosing healthcare professionals.

Types of Health Insurance Offered by Kaiser Permanente

Individual and Family Health Insurance Plans 

You have the option to purchase Kaiser health insurance plans through the Health Insurance Marketplace established by the Affordable Care Act (commonly known as “Obamacare”) or directly from Kaiser Permanente. When you buy insurance through the marketplace, you may qualify for health insurance tax credits, reducing your insurance costs.

Kaiser Permanente plans provide essential standard coverage, including access to free preventive care and screenings, along with financial safeguards like an out-of-pocket maximum. Plans are categorized into metal tiers: Bronze, Silver, Gold, and Platinum. Kaiser’s plans are also classified into three insurance categories, allowing you to choose based on your needs—Bronze Deductible plan, Gold Copayment plan, or a combination.

  • Health Savings Account (HSA) Plans: These are cost-effective, high-deductible plans. They enable you to establish a health savings account, allowing you to use pre-tax funds for doctor appointments and healthcare services, saving on taxes.
  • Deductible Plans: These plans function like traditional insurance, where you pay for most health services out of pocket until you reach your deductible. After reaching the deductible, you’ll pay a coinsurance rate as defined by your plan.
  • Copayment Plans: Available in Gold and Platinum tiers, these plans have higher monthly rates but no deductible. They are beneficial if you anticipate high medical costs, as you’ll only pay a copayment for covered services, potentially saving you money.

Medicare 

Kaiser Permanente provides a range of Medicare plans, available for direct purchase from the company or through Medicare.gov.

Plan Choices:
  • Medicare Advantage (Part C) Plans: These plans expand on the coverage provided by Original Medicare, offering additional cost-saving benefits and prescription drug coverage. Kaiser’s Medicare Advantage plans streamline your health coverage and have been recognized as top Medicare Advantage providers.
  • Medicare Advantage Plus Plans: Kaiser categorizes its Part C plans that not only include the benefits of Medicare Advantage but also provide coverage for dental care, hearing aids, and eyewear.
  • Prescription Coverage: Prescription drug coverage is available as part of a bundled Medicare Advantage plan. Stand-alone drug coverage plans (Medicare Part D) are not offered by Kaiser Permanente.

It’s important to note that Kaiser Permanente does not offer Medicare Supplement (Medigap) plans. If you’re seeking Medigap coverage, you may want to explore options with other top Medicare Supplement providers like UnitedHealthcare and Aetna.

Medicaid and programs for those with low incomes

Kaiser Permanente is actively involved in Medicaid initiatives, providing health coverage for individuals who qualify for low-income health insurance through government programs. 

Additionally, they have a Charitable Health Coverage program aimed at offering coverage and healthcare access to those not eligible for public or private health insurance. 

Moreover, they run a Medical Financial Assistance program, offering no-cost or reduced-price healthcare services to individuals with low income, lack of insurance, and limited access to healthcare services.

Employer and group insurance

Kaiser Permanente provides diverse plan options for employer and group insurance, offering a broader range compared to individual plans. In certain locations, they offer preferred provider organization (PPO) plans within group insurance, expanding medical coverage beyond Kaiser’s own facilities and medical professionals.

However, it’s important to note that while these PPO plans extend coverage, they may not have the same high customer satisfaction ratings as Kaiser’s HMO plans. For instance, the Kaiser Options PPO plan in Washington state is not recommended due to reported lower levels of customer satisfaction.

Medicare Advantage plans

  • HMO Plans: A Health Maintenance Organization plan necessitates using a specific network of doctors and hospitals. Typically, you require a referral from your primary doctor to consult a specialist, and benefits outside of the network are usually limited.
  • SNPs (Special Needs Plans): Special Needs Plans are designed for individuals with specific diseases or characteristics. The benefits, network, and drug formularies are customized to cater to the unique needs of these members. Kaiser Permanente offers a specific type of SNP known as the Dual-Eligible SNP, intended for individuals entitled to Medicare and also eligible for assistance from a state Medicaid program.

The costs associated with Kaiser Permanente Medicare Advantage plans can vary based on the specific plan, location, and individual health needs. Here are some key cost considerations:

How Much Do Kaiser Permanente Health Insurance Plans Cost?

Premiums
  • Approximately 48% of Kaiser Permanente’s Medicare Advantage plans for 2023 are $0-premium plans.
  • For plans with premiums, the monthly consolidated premium (including Part C and Part D) ranges from $17 to $296.
  • Dual-Eligible Special Needs Plans (D-SNPs) have monthly premiums ranging from $29 to $36.
  • Medicare Advantage users are still responsible for paying their Medicare Part B premium, which is $164.90 per month in 2023. However, some plans may cover part or all of this cost.
Copays, Coinsurance, and Deductibles
  • Copays, coinsurance, and deductibles vary depending on the specific plan, location, and services used.
  • Out-of-pocket costs may include copayments for visits or services (e.g., primary doctor visits, specialist visits) and deductibles (e.g., drug deductibles).
  • In-network and out-of-network out-of-pocket maximums, and costs for extra benefits, should also be considered.

It’s important to review the details of the specific Kaiser Permanente Medicare Advantage plan you’re considering to understand the precise costs and coverage associated with that plan:

Kaiser Permanente Medicare Advantage planPricing
Kaiser Permanente Medicare Advantage Centennial (HMO)Monthly premium: $0.Out-of-pocket max: $4,950.Copays:Primary care: $0.Specialist: $30.Tier 1 prescription drugs: $2.
Kaiser Permanente Medicare Advantage Basic (HMO)Monthly premium: $40.Out-of-pocket max: $4,200.Copays:Primary care: $0.Specialist: $30.Tier 1 prescription drugs: N/A.
Kaiser Permanente Medicare Advantage Columbia (HMO)Monthly premium: $49.Out-of-pocket max: $4,200.Copays:Primary care: $0.Specialist: $30.Tier 1 prescription drugs: $2.
Selected plans are available in ZIP code 99201.

Additional Advantages Offered by Kaiser Permanente

Kaiser Permanente provides a range of additional advantages with its health insurance plans, including:

  • Discounted rates on services like acupuncture, massage therapy, and chiropractic care.
  • Discounted rates on gym memberships and access to digital workout videos.
  • Wellness programs promoting a healthy lifestyle, aiding in weight loss, smoking cessation, and stress reduction through online platforms.
  • Personalized consultations with a wellness coach via phone.
  • Complimentary access to the Calm app, assisting in meditation, mindfulness, stress reduction, and better sleep.
  • Free access to the MyStrength app, aiding in mental health goal-setting, progress tracking, and managing conditions like depression and anxiety.

Please note that availability of these benefits may vary based on location.

4. Ambetter

Ambetter offers low-cost health insurance compared to others, but it’s not offered in every state. If you’re looking for basic coverage and added benefits at a reasonable monthly cost, Ambetter plans are a good option. 

However, satisfaction levels can vary depending on where you live, as different companies run Ambetter plans. 

Ambetter Health provides individual health insurance through state or federal marketplaces, or directly from an Ambetter insurance provider’s website.

Ambetter

Pros and Cons

Pros

  • Affordable average monthly rates compared to competitors.
  • Provides PPOs on the ACA marketplace, a less common option than HMOs and EPOs.
  • “My Health Pays” rewards program allows members to earn points to offset rates, copays, deductibles, and coinsurance.
  • Receives fewer consumer complaints filed with state regulators compared to many competitors.

Cons: 

Availability is limited, not offered in all states.

Types of Plans Offered by Ambetter

Ambetter provides three types of insurance plans through the health insurance marketplace:

  • HMO (Health Maintenance Organization): HMO plans necessitate using in-network providers, typically requiring a referral from your primary care doctor to see a specialist. HMO plans often have lower rates compared to other insurance types.
  • EPO (Exclusive Provider Organization): EPO plans mandate staying within the plan’s network for coverage, without needing a referral to see a specialist. Rates are usually similar to HMO plans and lower than PPO plans.
  • PPO (Preferred Provider Organization): PPO health plans offer flexibility to see providers outside the network without requiring a referral for specialists. However, out-of-network care is more expensive, and PPO premiums are generally higher than other plan types.

Ambetter has been rated three out of five stars by HealthCare.gov.

Health Insurance Options Available from Ambetter

Ambetter offers three types of individual health insurance plans, and your choice depends on your healthcare needs and budget.

  • Ambetter Essential Care (Bronze): These plans are the most budget-friendly but come with higher out-of-pocket costs when you use medical services. If you don’t need frequent medical care and want affordable monthly premiums, Bronze plans are a good option.
  • Ambetter Balanced Care (Silver): Silver plans have slightly higher rates than Bronze plans but offer more reasonable out-of-pocket expenses for healthcare. If you want to balance cost and out-of-pocket costs, choose Silver to avoid the high rates of Gold plans while still enjoying manageable out-of-pocket expenses.
  • Ambetter Secure Care (Gold): Gold plans have higher monthly premiums compared to Bronze and Silver plans, but they come with lower out-of-pocket costs when you need medical attention. Gold plans are ideal if you expect to use healthcare services in the upcoming year or prefer paying more each month to reduce costs when seeking care.

Plan costs

Ambetter Essential Care

The Ambetter Essential Care category includes multiple Bronze plans, each allowing the addition of vision and adult dental coverage, which would raise the monthly payment. Here are three instances of Essential Care plans. 

These plans are among the most affordable that Ambetter offers but come with the highest deductible levels. Bronze plans are suitable if you are in excellent health and do not anticipate many routine medical expenses. Generally, they are intended to cover significant, one-time medical expenses.

PlanMonthly costDeductibleOut-of-pocket max.
Ambetter Essential Care 1$385$8,600$8,600
Ambetter Essential Care 5$418$8,300$8,700
Ambetter Essential Care 2 HSA$423$6,900$6,900

The monthly price represents the typical amount for an individual aged 40 residing in Florida.

For Ambetter’s Essential Care 1 and Essential Care 2 plans, once you reach your deductible and out-of-pocket maximum, your medical expenses are covered at no cost. However, under Ambetter Essential Care 5 plans, you’ll have to make a copayment of $40 for each visit to your primary care doctor and $90 for every specialist appointment, regardless of whether you’ve met your deductible.

Ambetter Balanced Care

Ambetter Balanced Care plans fall into the Silver category, offering lower deductibles and out-of-pocket maximums compared to Bronze plans. However, they come with higher monthly premiums.

Here are a few of the Silver Ambetter Balanced Care options. You have the choice to include vision and dental coverage for an additional monthly premium.

PlanMonthly costDeductibleOut-of-pocket max.
Ambetter Balanced Care 30$503$6,100$6,100
Ambetter Balanced Care 12$530$6,500$8,400
Ambetter Balanced Care 11$537$6,000$8,500
Ambetter Balanced Care 24$547$7,450$7,450

The monthly price represents the typical amount for an individual aged 40 residing in Florida.

For certain Ambetter Balanced Care policies such as the Balanced Care 30 plan, you cover the full cost of your healthcare until you reach the deductible. After meeting the Balanced Care 30 deductible, the majority of your healthcare expenses are covered at no additional cost.

Ambetter Secure Care

The Ambetter Secure Care products belong to the Gold metal tier, which generally have higher monthly premiums but come with more reasonable deductibles and out-of-pocket maximums. These lower deductibles enable you to access your plan benefits promptly. Therefore, the Ambetter Secure Care Gold plan is ideal if you anticipate significant medical expenses, such as a monthly prescription.

Ambetter provides a single Gold plan, the Ambetter Secure Care 5, and offers the option to include vision and dental coverage.

Member support and distinct advantages

As an Ambetter policyholder, you gain access to additional benefits such as a rewards program and a nurse advice line. Through Ambetter’s My Health Pays rewards program, you can accumulate rewards dollars by completing wellness goals and tasks, which can be used for various expenses including plan payments, healthcare costs, utilities, and more.

Moreover, Ambetter offers a 24/7 nurse advice line that allows you to seek guidance on health concerns. Additionally, Ambetter provides a Wellframe mobile app to connect members with an advocate for assistance with healthcare needs and insurance inquiries. These benefits are accessible through the Ambetter online portal.

5. Humana

Humana, established in 1961, initially dealt with long-term care insurance and later diversified into largest health insurance companies.  As the fifth-largest health insurance company by revenue, it primarily emphasizes employer health insurance plans, dental and vision insurance. This includes Medicare Advantage, supplemental, and prescription plans. Notably, Humana hasn’t introduced new individual ACA health insurance since January 2018.

Humana Wellness

Key feature

  • Comprehensive benefits covering not only medical but also vision and dental care
  • Strong member satisfaction based on internal consumer feedback
  • Exceptional prescription coverage

Founded in 1961, Humana Inc. is the prominent health insurance compan headquartered in Louisville, Kentucky. It ranks as the fifth largest health insurance provider in the United States, serving nearly 9 million Medicare members, with over 5 million enrolled in Medicare Advantage plans.

Pros and Cons

Pros 

  • High Customer Satisfaction: Humana’s Medicare Advantage plans are highly rated for customer satisfaction, ranking second best by J.D. Power. It is also the top-ranked insurer offering plans nationwide, showcasing its commitment to customer service.
  • Wide Range of Options: Humana provides extensive options, including Medicare Advantage, Medicare Part D plans, and Medigap plans. You can choose from various plan types such as HMO, PPO, or PFFS Medicare Advantage plans based on your location.
  • Low-Cost High-Deductible Plan G: Humana offers a unique high-deductible Plan G Medicare Supplement, which is not widely available from other insurers. This plan comes at a low average premium, making it an attractive option for cost-conscious individuals. 
  • High Medicare Star Ratings: Humana’s Part D prescription drug plans have the highest average Medicare star rating, nearly 4 stars, among major providers. Additionally, their Medicare Advantage plans also maintain an impressive average rating of 4 stars, indicating a high level of quality.

Cons 

  • Limited Additional Coverage in the Gap: While Humana does offer insulin savings during the coverage gap as mandated by the Inflation Reduction Act, only about one-third of their Medicare Advantage plans provide additional drug coverage in the donut hole coverage gap, limiting options for some beneficiaries.
  • High Average Drug Deductible: Humana has the highest average drug deductible for Medicare Advantage plans. This compared to other insurers reviewed, potentially resulting in higher out-of-pocket costs for prescription medications.

Humana Medicare Advantage at a Glance

  • Plan Options: Humana offers diverse Medicare Advantage plan options, including HMOs, PPOs, and SNPs, to cater to different beneficiary needs.
  • Provider Network: The provider network size may vary based on location. For instance, in Pittsburgh, Humana has contracts with 224 family doctor providers.
  • Average Monthly Premium
  • Humana provides several plans with $0 monthly premiums.
  • The average premium for 2023 is approximately $18 per month.

Types of Medicare Advantage Plans Offered by Humana

Humana provides a variety of Medicare Advantage plans, each with unique features, costs, and benefits. Many plans offer dental and vision coverage, emergency care worldwide, and fitness perks through SilverSneakers.

Here’s an overview of the plan types available:

HMO Plans

Health Maintenance Organization plans require using a specific network of healthcare providers. Referrals from a primary doctor are often necessary to see a specialist, and out-of-network coverage is limited.

PPO Plans

Preferred Provider Organization plans offer more flexibility, allowing you to visit any provider that accepts the insurance. Choosing a primary doctor is not mandatory, and referrals for specialists are not required. Out-of-network care is an option but may cost more.

PFFS Plans

Private Fee-for-Service plans by Humana enable you to visit any Medicare-approved provider who accepts your Humana plan. You aren’t required to select a primary doctor, and referrals for specialists are not needed.

Special Needs Plans

These plans are tailored for individuals with specific diseases or characteristics. Humana offers two types of SNPs:

  • Chronic Condition SNP: Designed for individuals with conditions like diabetes, cardiovascular disorders, chronic heart failure, or chronic lung disorders.
  • Dual-Eligible SNP: Geared towards those eligible for Medicare and qualifying for assistance from a state Medicaid program.

In addition to these, Humana also offers Medicare Advantage prescription drug plans (MAPDs), stand-alone prescription drug plans, and Medicare Advantage plans without drug coverage. They’ve partnered with USAA to provide plans like the Humana USAA Honor with Rx plan, focusing on U.S. military veterans.

Humana Medicare Advantage costs

The cost of Humana Medicare Advantage plans can vary based on factors such as the specific plan, your location, and your health needs. Here’s an overview of the costs associated with these plans:

Premiums

  • Approximately 62% of Humana’s Medicare Advantage plans for 2023 have a $0 premium.
  • For plans with premiums, monthly consolidated premiums (including Part C and Part D) range from $4 to $199.
  • Special Needs Plans (SNPs) with premiums range from $4.10 to $39.90 per month.

Medicare Part B Premium

  • Medicare Advantage users still need to pay the Medicare Part B premium, which is at least $164.90 per month in 2023.

Copays, Coinsurance, and Deductibles

  • Costs for copays, coinsurance, and deductibles will depend on your specific plan, location, and the healthcare services you use.
  • Consider copayments and/or coinsurance for each visit or service, deductibles, and out-of-pocket maximums for both in-network and out-of-network services.

It’s essential to review the details of the specific Humana Medicare Advantage plan you’re considering to understand the exact costs and coverage associated with that plan. Additionally, factors like in-network vs. out-of-network care, extra benefits, and coverage for monthly Medicare Part B premiums can impact overall costs.

Humana Medicare Advantage planPricing
HumanaChoice H5216-318 (PPO)Monthly premium: $0.Out-of-pocket max: $3,600.Copays:Primary care: $0.Specialist: $30.Tier 1 prescription drugs: $0.
Humana Gold Plus H0028-054 (HMO-POS)Monthly premium: $0.Out-of-pocket max: $3,000.Copays:Primary care: $0.Specialist: $20.Tier 1 prescription drugs: $0.
Humana Honor H5216-140 (PPO)Monthly premium: $0.Out-of-pocket max: $4,500.Copays:Primary care: $0.Specialist: $35.Tier 1 prescription drugs: N/A.
Selected plans are available in ZIP code 66013.

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