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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 2025, 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 4 out of 5 stars in 2025.
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 $200.00 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 $12300.00 (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 $12300.00 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 has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for a preferred generic drug, you'll pay a $12 copay at a standard or preferred mail pharmacy, or a $20 copay at a standard mail pharmacy. For preferred brand drugs, you will pay 42% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H0473-003 (PPO) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays for different services. Emergency, primary care, preventive, and home health services often have no copay or low copays, while other services like ambulance, vision, and dental have specific copays or coinsurance. The plan also covers hearing, vision, and dental services, with specific limits and cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $325 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days 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 $40 and $300, observation services with a $325 copay, ambulatory surgical center services with a $210 copay, individual and group outpatient substance abuse sessions with a copay between $30 and $50, and outpatient blood services with no copay. Prior authorization is required for all of these services.
Partial Hospitalization See details
HumanaChoice H0473-003 (PPO) covers partial hospitalization with a $45 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
For HumanaChoice H0473-003 (PPO), Ambulance Services are covered with a $315 copay for ground ambulance services and 20% coinsurance for air ambulance services, while 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 by HumanaChoice H0473-003 (PPO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and all services have no coinsurance.
Primary Care See details
The HumanaChoice H0473-003 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. Physician specialist services have a $40 copay. Individual and group sessions for mental health and psychiatric services have a $30 copay, while 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 $50. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by HumanaChoice H0473-003 (PPO), including an annual physical exam with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit also have no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
HumanaChoice H0473-003 (PPO) covers vision services, including eye exams with a copay of $0-$40 and eyewear with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, with a limit of 1 pair per year for each service.
Dental Services See details
Dental Services are covered, with a $2,000 maximum benefit per year. Medicare Dental Services have a $40 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Restorative Services and Prosthodontics, fixed have a coinsurance between 30% and 40%, and Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery have no copay. Fluoride Treatment, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B Drugs with 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs also have a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H0473-003 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance and requires prior authorization, while Diabetic Supplies have a 10-20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a copay between $0 and $175, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, and Therapeutic Radiological Services have a copay up to $45 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H0473-003 (PPO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but all of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with no copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture and a meal benefit. Acupuncture has a $40 copay per visit, and the plan covers up to 20 treatments per year with prior authorization required. The meal benefit has no copay and also requires prior authorization.
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