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HumanaChoice H0473-004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H0473-004 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H0473-004 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H0473-004 (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 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H0473-004 (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 H0473-004 (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 H0473-004 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 $420.00 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 $13100.00 (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 $13100.00 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 H0473-004 (PPO) Medicare plan features an annual prescription drug deductible of $420. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a 1-month supply, with no copay required for a 3-month supply filled via preferred mail order. Tier 3 preferred brand-name drugs carry a $47 copay for a 1-month supply, which can be reduced to a $131 copay for a 3-month supply through preferred mail order. For Tier 4 non-preferred drugs, you will pay a 50% coinsurance across standard pharmacies and mail order options. Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H0473-004 (PPO) plan provides core medical coverage with no copay for primary care visits and a $35 copay for specialists. Inpatient hospital stays require a daily copay of $345 for the first six days of acute care, while emergency room visits have a $115 copay that is waived upon admission. Outpatient hospital services are also accessible, ranging from no copay to a $315 copay with no coinsurance. For ancillary care, members enjoy no copay for annual physicals, routine eye exams, select eyewear, and most dental services up to a $1,000 annual limit. Skilled nursing facility stays for the first 20 days and home health services also require no copay, while prescription hearing aids are covered with copays between $699 and $999. Diagnostic lab work and X-rays require no copay, though durable medical equipment and dialysis services require an 18% to 20% coinsurance.
Inpatient Hospital See details
HumanaChoice H0473-004 (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $345 for days 1 to 6 of acute stays and $335 for days 1 to 6 of psychiatric stays, followed by no copay for remaining covered days. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H0473-004 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $315 copay for outpatient hospital services and a $345 copay per stay for observation services. Outpatient substance abuse sessions require a $30 to $35 copay, while ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H0473-004 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H0473-004 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, both of which require prior authorization. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H0473-004 (PPO) covers emergency services with a $115 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered under the plan with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H0473-004 (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapies carry a $25 copay with no coinsurance, whereas mental health and psychiatric individual or group sessions cost a $30 copay with no coinsurance. Podiatry is not covered, and chiropractic services are only partially covered at a $15 copay and no coinsurance, with routine and other chiropractic care excluded.
Preventive Services See details
Preventive services are covered by HumanaChoice H0473-004 (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, and diabetes training. Additional preventive services are partially covered, offering a memory fitness benefit, but excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemo wigs, weight management, alternative therapies, therapeutic massage, and adult day health. Also not covered are nutritional benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H0473-004 (PPO) covers hearing services, offering Medicare-covered exams for a $35 copay and routine exams or fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 and no coinsurance for up to two devices per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HumanaChoice H0473-004 (PPO) vision services are partially covered, featuring no copay and no coinsurance for one routine eye exam and select eyewear, such as contact lenses or complete eyeglasses, per year. Other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H0473-004 (PPO), offering a $1,000 annual limit with no copay and no coinsurance for most preventive and comprehensive care, and a $35 copay and no coinsurance for Medicare-covered dental. Under this benefit, fluoride, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H0473-004 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B drugs, such as chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by HumanaChoice H0473-004 (PPO) with a 20% coinsurance and no copay, though prior authorization is required.
Medical Equipment See details
HumanaChoice H0473-004 (PPO) covers durable medical equipment (DME) with an 18% coinsurance and no copay, and prosthetics and medical supplies with a 20% coinsurance and no copay. Covered diabetic supplies have a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts carry a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H0473-004 (PPO) covers diagnostic and radiological services, requiring prior authorization for these benefits. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $175, while lab services and outpatient X-rays feature no copay. Diagnostic radiological services start at no copay, whereas therapeutic radiological services require a $35 copay and at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H0473-004 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by HumanaChoice H0473-004 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, specific programs including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H0473-004 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the 100-day limit are not covered.
Other Services See details
HumanaChoice H0473-004 (PPO) partially covers other services, providing acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year, and meal benefits for chronic or qualifying illnesses with no copay and no coinsurance. Prior authorization is required for both covered services, while over-the-counter (OTC) items are not covered.
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