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HumanaChoice H0473-003 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H0473-003 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H0473-003 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H0473-003 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Hays, Travis and Williamson counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H0473-003 (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 H0473-003 (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 H0473-003 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $91.00. 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 $615.00 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 H0473-003 (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics, you will pay no copay for 1-month or 3-month supplies filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost a $12 copay for a 1-month supply at standard pharmacies and preferred mail order, but you can get a 3-month supply through preferred mail order with no copay. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with 3-month supplies costing $131 through preferred mail order and $141 at standard pharmacies. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 49% coinsurance for both 1-month and 3-month supplies. Finally, Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply across all standard and mail-order options.
Additional Benefits
The HumanaChoice H0473-003 (PPO) plan offers affordable access to essential medical care, featuring no copays or coinsurance for primary care visits and routine preventive services. Specialists are available for a low $35 copay, while emergency room visits cost a $115 copay which is waived upon hospital admission. For hospital stays, members pay a $325 daily copay for the first five days of inpatient care and no copay for outpatient ambulatory surgical services. This plan also includes valuable supplemental coverage, such as a $2,000 annual dental benefit with no copays for preventive care, alongside no copays for routine vision and hearing exams. Prescription hearing aids require copays ranging from $299 to $899, while durable medical equipment is covered with a 20% coinsurance and no copay. Additionally, skilled nursing facility care is highly affordable, featuring no copay for the first 20 days of your stay.
Inpatient Hospital See details
HumanaChoice H0473-003 (PPO) offers partially covered inpatient hospital care with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. While unlimited additional acute care days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H0473-003 (PPO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and outpatient blood services. Patients will pay a copay of $0 to $300 for outpatient hospital services, $325 per stay for observation services, and $30 to $35 per session for outpatient substance abuse services.
Partial Hospitalization See details
HumanaChoice H0473-003 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H0473-003 (PPO) covers ambulance services with prior authorization, requiring a $280 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by HumanaChoice H0473-003 (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H0473-003 (PPO) covers primary care physician services with no copay and specialist visits with a $35 copay, both with no coinsurance. Other benefits like physical therapy ($25 copay), mental health ($30 copay), and telehealth ($0-$40 copay) also feature no coinsurance, while podiatry is not covered and chiropractic care is partially covered with a $15 copay and no coinsurance for routine visits, excluding other chiropractic services.
Preventive Services See details
HumanaChoice H0473-003 (PPO) preventive services are covered with no copay and no coinsurance, including annual physicals, kidney disease education, memory fitness, glaucoma screenings, diabetes training, digital rectal exams, and post-welcome visit EKGs. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
HumanaChoice H0473-003 (PPO) hearing services are covered, featuring a $35 copay for Medicare-covered exams and no copay for routine exams and fitting evaluations, with no coinsurance for these visits. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $299.00 to $899.00, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H0473-003 (PPO) offers partial vision coverage with no coinsurance and no copay for one annual routine eye exam (up to $75) and one pair of eyeglasses or contact lenses (up to $250 yearly). Other eye exams, separate lenses, separate frames, and upgrades are not covered under this plan.
Dental Services See details
HumanaChoice H0473-003 (PPO) partially covers dental services up to a $2,000 combined annual limit, with no copay and no coinsurance for preventive, diagnostic, endodontic, periodontic, and oral surgery services. Restorative and fixed prosthodontics are covered with no copay and 30% to 40% coinsurance, while Medicare-covered dental services require a $35 copay and no coinsurance. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H0473-003 (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H0473-003 (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H0473-003 (PPO) covers durable medical equipment (DME), prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H0473-003 (PPO) with prior authorization required. Diagnostic tests have no coinsurance and a $0 to $175 copay, lab services and outpatient X-rays have no copay, while therapeutic radiological services require a minimum 20% coinsurance and a $45 minimum copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H0473-003 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by HumanaChoice H0473-003 (PPO) with no coinsurance, but in practice, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H0473-003 (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H0473-003 (PPO) partially covers other services, offering acupuncture and meal benefits with no copay and no coinsurance, though prior authorization is required. Acupuncture is limited to 25 treatments per year, while over-the-counter (OTC) items are not covered.
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