Plan Options & Coverage Types

HMO, PPO, POS, EPO Differences

• Elevance Health offers a full range of plans including HMO, PPO, EPO, and POS, depending on your state and employer options. Their PPO and EPO plans are especially strong for those wanting broader provider choice.
• Humana primarily offers HMO and PPO plans, especially in the Medicare Advantage and employer-sponsored spaces. HMO plans are more common and come with lower premiums but require referrals.

Individual Plans vs. Employer-Sponsored Plans

• Elevance Health offers both individual ACA marketplace plans and extensive employer-sponsored coverage, including self-funded and fully insured options.
• Humana largely focuses on employer-sponsored and Medicare Advantage plans and has limited availability in the ACA marketplace.

Medicare Advantage vs. Medicare Supplement

• Elevance Health offers Medicare Advantage and Medigap (Supplement) plans through its regional affiliates under the Blue brand.
• Humana is one of the largest Medicare Advantage providers in the U.S., offering comprehensive plans often with extra perks. They also offer Medigap plans, though Medicare Advantage remains their core focus.

Medicaid and ACA Marketplace Options

• Elevance Health participates in Medicaid and ACA exchanges in multiple states through Blue-branded affiliates.
• Humana has limited Medicaid and ACA presence, having exited most individual ACA markets in recent years.

Cost & Affordability

Monthly Premiums Comparison

• Elevance Health premiums vary significantly by plan and region, especially on the ACA marketplace. PPOs generally have higher monthly costs than HMOs.
• Humana is known for offering low or $0 premium Medicare Advantage plans, making them appealing to seniors on fixed incomes.

Deductibles and Copayments

• Elevance Health offers plans with a wide range of deductibles and copays, depending on the plan type (HMO vs. PPO).
• Humana’s Medicare Advantage plans often come with predictable, low copays, especially for routine care.

Out-of-Pocket Maximums

• Elevance plans may have higher out-of-pocket limits, especially in PPO and ACA plans.
• Humana offers low out-of-pocket maximums, particularly in HMO-style Medicare Advantage plans.

Pricing Transparency

• Both insurers offer cost estimator tools and member portals, though Humana’s MyHumana app is more user-friendly for many.

Network Size & Provider Accessibility

Size and Geographic Reach of Provider Networks

• Elevance Health, through its Blue Cross Blue Shield affiliations, provides access to one of the largest networks in the U.S.
• Humana has a large Medicare Advantage network but is more limited geographically, especially outside of senior-focused care.

Specialist Access and Referrals

• Elevance’s PPO plans allow direct specialist access, while HMO plans require referrals.
• Humana’s Medicare HMOs generally require referrals; PPO plans do not.

Availability of In-Network Hospitals and Doctors

• Elevance Health has partnerships with top hospitals and health systems nationwide.
• Humana contracts with a broad range of providers, particularly those specializing in senior care and chronic condition management.

Out-of-Network Coverage and Reimbursement Rates

• Elevance offers strong out-of-network coverage in PPOs, while HMO plans are more restrictive.
• Humana’s PPO Advantage plans include out-of-network benefits, but HMOs are limited to in-network care.

Member Benefits & Perks

Wellness Incentives (Fitness Memberships, Preventive Screenings)

• Elevance Health offers Blue365, a wellness discount program with deals on gym memberships, fitness trackers, and nutrition support.
• Humana provides SilverSneakers fitness programs, preventive health screenings, and wellness rewards via Go365.

Chronic Disease Management Programs

• Both companies offer comprehensive disease management for diabetes, hypertension, and heart disease. Humana’s programs are especially tailored to seniors.

Telehealth and Virtual Care Offerings

• Elevance partners with services like Teladoc and LiveHealth Online for 24/7 virtual visits.
• Humana has robust telehealth features built into its Medicare Advantage plans, offering virtual visits for both primary and behavioral care.

Mental Health Coverage and Services

• Elevance includes a wide network of in-person and virtual behavioral health services.
• Humana offers mental health coverage through its Medicare and employer plans, including virtual therapy sessions.

Customer Service & Member Experience

Customer Satisfaction Ratings (J.D. Power, NCQA)

• Humana consistently scores high marks for Medicare Advantage customer satisfaction.
• Elevance Health’s ratings vary by state and affiliate, with mixed reviews on ACA plan support.

Ease of Claims Processing and Disputes

• Humana receives positive feedback for easy claims and billing processes, especially for seniors.
• Elevance Health offers digital claims submission but may have variability across regional providers.

Quality and Usability of Online Portals/Apps

• Humana’s MyHumana app is highly rated for ease of use and plan navigation.
• Elevance provides solid tools, though the experience may vary by state affiliate.

Responsiveness of Customer Support

• Humana has a senior-focused, responsive service team.
• Elevance Health support is region-specific; some affiliates are highly rated, while others are average.

Reputation & Financial Stability

Financial Strength Ratings (A.M. Best, Moody’s, S&P)

• Elevance Health and Humana both have strong ratings (A to A+), indicating financial reliability and long-term stability.

Company Reputation and Market History

• Elevance (Anthem) has a long-standing presence through its Blue Cross Blue Shield branding.
• Humana is one of the most trusted names in Medicare Advantage, with over 60 years in the healthcare industry.

Consumer Complaints and Regulatory Issues

• Both companies maintain moderate complaint ratios with state insurance departments, with occasional issues related to billing or prior authorization.

Medicare-Specific Criteria

Medicare Star Ratings & Member Satisfaction

• Humana Medicare Advantage plans often receive 4+ star ratings, with some plans achieving 5 stars.
• Elevance’s Medicare Advantage plans also rate well but vary by region.

Medicare Advantage Additional Benefits (Vision, Dental, Hearing)

• Both providers include comprehensive extra benefits in their Medicare Advantage plans.

Availability and Quality of Medigap Plans

• Humana and Elevance both offer Medigap (Supplement) plans, though Elevance’s offerings may be more widespread via BCBS affiliates.

Cost-Sharing Details

• Both insurers structure cost-sharing to minimize out-of-pocket costs in Advantage plans, especially for preventive and primary care.

Employer & Small-Business Focus

Options for Small-Business Health Plans

• Elevance Health offers robust small-business and group coverage, with custom solutions across industries.
• Humana also provides small-business coverage, but its focus is narrower compared to Elevance.

Fully Insured vs. Self-Funded Plans

• Both companies offer fully insured and self-funded health plan options.

Employee Wellness Initiatives and Incentives

• Humana’s Go365 and Elevance’s Blue365 provide employee health engagement platforms, rewards, and biometric screenings.

Customization & Flexibility of Group Policies

• Elevance shines in group plan flexibility, especially through its Blue-branded networks.
• Humana also allows customization, especially for Medicare group retiree coverage.