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HumanaChoice H0473-005 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H0473-005 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H0473-005 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H0473-005 (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 H0473-005 (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 H0473-005 (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 H0473-005 (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 has a $130.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $11900.00 (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 $11900.00 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 H0473-005 (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a 1-month supply at standard pharmacies, with no copay for a 3-month supply when using preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at standard pharmacies and preferred mail order. Tier 4 non-preferred drugs carry a 50% coinsurance across all pharmacy and mail order options for both 1-month and 3-month supplies. Tier 5 specialty tier drugs require a 25% coinsurance for a 1-month supply at all standard and preferred pharmacies.
Additional Benefits
The HumanaChoice H0473-005 (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care doctor visits and annual preventive exams. Specialist visits require a $35 copay, while inpatient hospital stays carry a daily copay of $315 for the first seven days of acute care with no coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also covers routine dental, vision, and hearing exams with no copay, though prescription hearing aids require a copay and eyewear is subject to a $150 annual limit. Additionally, home health services are covered with no copay, while skilled nursing facility stays feature no copay for the first 20 days. For medical equipment and dialysis services, members can expect coinsurance costs of 5% and 20% respectively, with no copays.
Inpatient Hospital See details
HumanaChoice H0473-005 (PPO) inpatient hospital benefits feature no coinsurance, requiring a daily copay of $315 for days 1 to 7 of acute care and $290 for days 1 to 7 of psychiatric care, with no copay for subsequent days. Prior authorization is required, and certain services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H0473-005 (PPO) outpatient services are covered with no coinsurance, including outpatient hospital services with a $0 to $350 copay and observation services with a $315 copay per stay. Ambulatory surgical center and outpatient blood services are offered with no copay, while outpatient substance abuse sessions carry a $30 to $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the HumanaChoice H0473-005 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice H0473-005 (PPO) covers Medicare-covered ground and air ambulance services with a $335.00 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice H0473-005 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H0473-005 (PPO) primary care benefits are partially covered, offering primary care physician visits with no copay and no coinsurance, and specialist visits for a $35 copay and no coinsurance. Mental health, therapy, telehealth, and psychiatric services are also covered with copayments ranging from $0 to $40 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H0473-005 (PPO) preventive services are covered with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, and screenings. However, additional preventive benefits are partially covered, excluding health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Hearing services are covered under the HumanaChoice H0473-005 (PPO) plan, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay and no coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H0473-005 (PPO), offering routine eye exams and eyewear with no copay and no coinsurance, subject to a $150 annual limit for eyeglasses and contact lenses. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H0473-005 (PPO), with Medicare-covered dental services requiring a $35 copay and no coinsurance, and other covered preventive and comprehensive services available with no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H0473-005 (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization and step therapy. Covered Medicare Part B drugs, such as chemotherapy and insulin, have coinsurance ranging from no coinsurance to 20%, with insulin carrying a $35 copay and other Part B drugs requiring no copay.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H0473-005 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
HumanaChoice H0473-005 (PPO) covers durable medical equipment (DME) with a 5% coinsurance and no copay, and prosthetic devices or medical supplies with an 18% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance, with prior authorization required for medical equipment.
Diagnostic and Radiological Services See details
HumanaChoice H0473-005 (PPO) covers diagnostic procedures with a $0 to $250 copay and no coinsurance, and lab services with no copay and no coinsurance. Radiological services are also covered, featuring a copay starting at $0 for diagnostic radiology, no copay for outpatient X-rays, and a minimum $35 copay and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by HumanaChoice H0473-005 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the HumanaChoice H0473-005 (PPO) plan with no coinsurance, although in practice only some services are covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by HumanaChoice H0473-005 (PPO) with no coinsurance and no prior three-day hospital stay required, although prior authorization is necessary. This benefit is partially covered, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the HumanaChoice H0473-005 (PPO) plan are partially covered, featuring acupuncture with a $35.00 copay and no coinsurance (limited to 20 treatments per year) and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit, and prior authorization is required for the covered services.
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