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HumanaChoice H0473-001 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H0473-001 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H0473-001 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H0473-001 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that HumanaChoice H0473-001 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice H0473-001 (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HumanaChoice H0473-001 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $12500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $12500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HumanaChoice H0473-001 (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you'll pay $9 or $20 for a preferred generic drug, depending on the pharmacy. For preferred brand drugs, you pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H0473-001 (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services with varying copays. The plan also covers primary care with no copay, and offers coverage for hearing, vision, and dental services, with specific copays and coverage details for each. Other benefits include ambulance services with a copay and coinsurance, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $345 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $335 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $435, observation services with a $345 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $30 and $100 for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for most services.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H0473-001 (PPO) plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice H0473-001 (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The HumanaChoice H0473-001 (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a $25 copay, and physician specialist services have a $40 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $45, and opioid treatment program services have a copay between $30 and $100.
Preventive Services See details
The HumanaChoice H0473-001 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, are covered with a copay.
Hearing Services See details
The HumanaChoice H0473-001 (PPO) plan covers hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with only the "all types" category covered, with a copay between $699 and $999. OTC hearing aids are covered, with a maximum benefit of $20 per month.
Vision Services See details
The HumanaChoice H0473-001 (PPO) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $40 copay for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice H0473-001 (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, and Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H0473-001 (PPO) plan, with a coinsurance of 20%. Prior authorization is required for this service.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a minimum copay of $0.00 and a maximum copay of $175.00 for Diagnostic Procedures/Tests. Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325.00, and Therapeutic Radiological Services have a copay of at most $45.00 and a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H0473-001 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H0473-001 (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H0473-001 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Under "Other Services," HumanaChoice H0473-001 (PPO) covers acupuncture with a $40 copay, and a limit of 20 treatments per year; it also offers over-the-counter (OTC) items with a maximum benefit of $20 per month, and a meal benefit with no copay. Some services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others.
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