Payer Performance Ranking: How Humana and Medicare Stand Out

In the dynamic and often complex world of healthcare, payer performance plays a crucial role in shaping the quality of patient care and the financial health of healthcare providers. Payer performance refers to how efficiently and effectively insurance companies process claims, reimburse providers, and offer coverage to beneficiaries. Humana and Medicare have consistently stood out as leaders in this space, earning top rankings for their customer service, provider networks, and efficient claims processing. This blog explores why Humana and Medicare lead in payer performance, supported by facts, figures, and performance metrics.

What Is Payer Performance?

Payer performance is evaluated using various metrics, including:

• Claim accuracy and processing speed: Timeliness and accuracy of claims payments.
• Customer service and satisfaction: How well insurance companies handle customer inquiries, grievances, and overall experience.
• Reimbursement rates and timeliness: The speed and consistency with which providers are paid for the services rendered to insured individuals.
• Network coverage: The extent and quality of healthcare providers within the payer’s network.
• Quality of care: The healthcare outcomes of insured members, as measured through health outcomes and patient satisfaction surveys.

In an industry that is under constant scrutiny for its operational efficiency and service quality, payer performance is a critical factor for both patients and healthcare professionals.

Humana’s Payer Performance in the Healthcare Market

Humana is one of the largest health insurance providers in the United States, particularly recognized for its leadership in the Medicare Advantage market. Humana has consistently ranked highly in terms of customer satisfaction, innovation, and efficiency. Here’s why:

96% of Humana’s Medicare Advantage Members are in Contracts rated 4-Star or Above for 2023; 66% are in Contracts Rated 4.5-Star or Higher

• In 2023, Humana achieved a 4.5 out of 5 stars in the Medicare Advantage Star Ratings. The star rating system evaluates health plans on customer service, quality of care, and member satisfaction. Humana’s high rating reflects its strong customer service and high member satisfaction levels.
• According to J.D. Power’s 2023 U.S. Medicare Advantage Study, Humana ranked third among major Medicare Advantage insurers, highlighting its effectiveness in addressing members’ needs.

LOUISVILLE, Ky.– (BUSINESS WIRE)– Humana Inc. (NYSE: HUM), a leading health and well-being company in the United States, announced the Medicare Star Ratings for its Medicare Advantage plans, effective January 1, 2023, as provided by the Centers for Medicare and Medicaid Services (CMS).

With 4.9 million of Humana’s Medicare Advantage members enrolled in plans with ratings of 4 stars or higher, the company’s strong Star Ratings reflect its ongoing commitment to delivering high-quality care, patient-focused clinical results, and dependable customer service.

“We are incredibly proud of our continued success in Medicare Star Ratings, which highlights our dedication to providing exceptional care and positive customer experiences,” stated Alan Wheatley, President of the Retail Segment at Humana.

Humana’s impressive ratings, even before the onset of COVID-19, demonstrate the strength of its Medicare Advantage plans, as noted by George Renaudin, President of Medicare at Humana.

Three of Humana’s contracts have achieved a 5-star rating in the CMS 5-star rating system. These include HMO plans in Louisiana, Tennessee, and Kentucky, serving approximately 356,000 members. The contracts with this distinction are Cariten Health Plan Inc. in Tennessee, Humana Health Benefit Plan of Louisiana, Inc. in Louisiana, and Humana Health Plan of Ohio, Inc. in Kentucky, all earning the 5-star rating for the second consecutive year. Additionally, Humana received a 4.5-star rating for seven Medicare Advantage contracts available across 46 states and Puerto Rico, covering over 3 million members—nearly double the number of members in 4.5-star plans compared to 2022.

In total, Humana will offer plans under 47 Medicare Advantage contracts in 2023, with 30 of them rated 4 stars or higher, currently covering 4.9 million members. This represents 96% of its Medicare Advantage membership in rated contracts as of September 2022. Furthermore, over 99% of retirees enrolled in Humana’s Group Medicare Advantage rated plans will remain in contracts rated 4 stars or higher in 2023. Humana Medicare Advantage member Alan Grofe shared that he remains loyal to Humana due to its consistently excellent plan options tailored to his needs.

Innovative Programs and Preventive Care

Humana’s commitment to preventive care has resulted in impressive program results:

• Humana’s Medicare Advantage Plans offer $0 premiums on certain plans and provide additional benefits like fitness programs, dental, and vision coverage.
• Humana’s focus on preventive care helps reduce hospital readmissions and unnecessary procedures. For instance, in 2022, Humana’s Medicare Advantage members had lower hospital readmission rates compared to the national average.

Efficient Claims Processing

• Humana has been recognized for its fast claims processing. According to Centers for Medicare & Medicaid Services (CMS) 2023 data, Humana processes over 95% of claims accurately and on time.

Expanding Coverage Options

Humana continues to expand its network of doctors, hospitals, and specialists:

• Humana partners with over 300,000 healthcare providers nationwide, ensuring members have access to a wide variety of healthcare services.

Medicare’s Lead in Payer Performance

As a government-funded program, Medicare has a critical role in providing healthcare for older adults and individuals with disabilities. Medicare has earned top marks in payer performance, largely due to its comprehensive coverage and high quality of care:

Comprehensive Coverage

Medicare offers several options:

• Medicare Part A (hospital insurance) covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services.
• Medicare Part B (medical insurance) covers outpatient care, doctor visits, and preventive services.
• Medicare Advantage (Part C) allows beneficiaries to get all their Part A and Part B benefits through private insurance plans.
• Medicare Part D offers prescription drug coverage.

In 2023, approximately 30 million beneficiaries were enrolled in Medicare Advantage, reflecting its growing popularity due to its additional benefits, which go beyond Original Medicare.

Quality Ratings and Performance

Medicare uses a five-star rating system to evaluate Medicare Advantage plans, which reflects patient satisfaction and quality of care. As of 2023:

• 39% of Medicare Advantage plans have received 4 stars or higher (on a 5-star scale) from the Centers for Medicare & Medicaid Services (CMS). This rating indicates high-quality services and beneficiary satisfaction.

Efficiency in Claims and Reimbursement

Medicare’s efficiency in claims processing is crucial for providers:

• Medicare’s claims processing time averages around 14 days for claims submitted electronically.
• Medicare’s reimbursement rate for hospitals is typically higher than private insurers, which ensures that healthcare providers are fairly compensated for the services provided to beneficiaries.

Wide Network of Providers

• Medicare covers services from over 1.5 million healthcare providers, which includes doctors, hospitals, skilled nursing facilities, and pharmacies. This extensive network ensures that beneficiaries can access quality care across the country.

Humana vs. Medicare: A Comparison of Payer Performance

While Humana and Medicare share several similarities in terms of payer performance, they operate under different structures. Here’s a side-by-side comparison based on specific performance metrics:

Payer	Claim Accuracy	Customer Satisfaction	Coverage Options	Provider Network	Reimbursement Speed
Humana	95%+	4.5/5 (Medicare Advantage)	Wide (Medicare Advantage, Part D)	300,000+ providers	Fast (95% claims on time)
Medicare	97%	4.5/5 (Medicare Advantage)	Comprehensive (Part A, B, C, D)	1.5 million+ providers	14 days for e-claims

Both Humana and Medicare excel in different areas:

• Humana leads in innovation with value-added services like wellness programs, dental coverage, and fitness plans.
• Medicare excels in coverage breadth, especially for seniors, and has a more extensive network of healthcare providers.

Humana 5.0-Star Rated Contracts

• H0292: Humana Health Plan of Ohio, Inc. (Kentucky HMO)
• H1951: Humana Health Benefit Plan of Louisiana, Inc. (Louisiana HMO)
• H4461: Cariten Health Plan Inc. (Tennessee HMO)

Humana 4.5-Star Rated Contracts

• H0473: Humana Insurance Company of Kentucky (Texas LPPO)
• H1036: Humana Medical Plan, Inc. (Florida, Kentucky, Mississippi, North Carolina, Oregon HMOs)
• H1468: Humana Benefit Plan of Illinois, Inc. (Illinois HMO)
• H4007: Humana Health Plans of Puerto Rico, Inc. (Puerto Rico HMO)
• H5216: Humana Insurance Company (LPPOs in Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Kansas, Louisiana, Massachusetts, Maryland, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Washington, West Virginia, Wisconsin, Wyoming)
• H6622: Humana WI Health Organization Insurance Corp. (HMOs in Delaware, Kentucky, Maryland, Minnesota, Mississippi, Montana, North Carolina, New Jersey, Nevada, Ohio, Oklahoma, Pennsylvania, Virginia, Wisconsin)
• R0865: Humana Insurance Company (RPPOs in Indiana, Kentucky)

Additional Information for Investors about Humana

Investors can access detailed information about Humana through the Investor Relations section of the company’s website at humana.com. Available resources include:

• Annual reports for stockholders.
• Filings with the Securities and Exchange Commission (SEC).
• Presentations from the most recent investor conferences.
• Quarterly earnings announcements and conference call recordings.
• A calendar of upcoming events.
• Corporate governance details.

About Humana
Humana operates as a Medicare Advantage HMO, PPO, and PFFS organization, as well as a stand-alone prescription drug plan provider under a Medicare contract. Enrollment in any Humana plan is contingent upon the renewal of the Medicare contract. Each year, Medicare evaluates plans using a 5-star rating system to measure performance and quality.

Other Notable Payers in the Industry

While Humana and Medicare are at the top, other major payers are also noteworthy for their performance in the healthcare payer market:

• Aetna: Aetna has a 4.2/5 star rating for its Medicare Advantage plans and offers a comprehensive suite of health insurance plans, including dental, vision, and hearing coverage.
• UnitedHealthcare: With over 27 million members in its Medicare Advantage plans, UnitedHealthcare has one of the largest networks and was ranked first for customer satisfaction in J.D. Power’s 2023 study.
• Cigna: Cigna offers strong customer support, with a focus on care coordination and managing chronic conditions. Cigna’s Medicare Advantage plans cover over 2.5 million beneficiaries.

Future Outlook for Healthcare Payers

Looking ahead, the healthcare payer landscape is expected to evolve with new technologies and policies. Some key trends include:

• Value-based care models that emphasize quality over quantity, rewarding healthcare providers for improving patient outcomes.
• Telemedicine and digital health tools will continue to play a significant role in payer performance, with insurers increasingly offering virtual care options to enhance patient access.
• Artificial intelligence (AI) will streamline claims processing, fraud detection, and care management.

Both Humana and Medicare are already adapting to these trends, with the goal of improving care delivery and operational efficiency.

Conclusion

Humana and Medicare lead the way in payer performance, offering comprehensive coverage, high-quality care, and excellent customer service. With impressive ratings in customer satisfaction, efficient claims processing, and a broad network of healthcare providers, both insurers provide substantial value to patients and healthcare providers alike.

As the healthcare industry evolves, Humana and Medicare are poised to maintain their leadership roles by embracing innovation and improving healthcare access and outcomes. Healthcare providers and patients alike can benefit from the stability and efficiency these leading payers bring to the table.