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HumanaChoice H5525-004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-004 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-004 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-004 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Peoria Illinois area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-004 (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 H5525-004 (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 H5525-004 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $60.00. 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 $10100.00 (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 $10100.00 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 H5525-004 (PPO) prescription drug plan features an annual drug deductible of $615. 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 drugs require a $47 copay for a 1-month supply, with a reduced copay of $131 for a 3-month supply when using preferred mail order. Tier 4 non-preferred drugs are subject to a 49% coinsurance across standard pharmacies and mail-order options. Specialty medications in Tier 5 carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H5525-004 (PPO) plan offers comprehensive medical coverage with no copay for primary care doctor visits and a $50 copay for specialists. Inpatient hospital stays require a $350 daily copay for the first six days, while subsequent days up to 90 days have no copay. Outpatient services, preventive care, and home health services are also highly accessible, often requiring no copay or coinsurance. For supplemental care, the plan features dental benefits up to a $1,000 annual limit with no copay for preventive services, alongside routine vision and hearing exams at no cost. Prescription hearing aids are available with copays ranging from $699 to $999, while durable medical equipment requires a 20% coinsurance. Emergency care is covered with a $130 copay, which is waived if you are admitted to the hospital.
Inpatient Hospital See details
HumanaChoice H5525-004 (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $350 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5525-004 (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most treatments. Outpatient hospital services require a $0 to $300 copay, observation services carry a $350 copay per stay, and substance abuse sessions cost $30 to $35, while ambulatory surgical center and blood services are fully covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the HumanaChoice H5525-004 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5525-004 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, requiring prior authorization for both. For transportation, some services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
HumanaChoice H5525-004 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-004 (PPO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $50 copay and no coinsurance. Therapy services require a $40 copay with no coinsurance, podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5525-004 (PPO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training with no copay and no coinsurance. Additional preventive services are partially covered, offering a memory fitness benefit with no copay or coinsurance, while other services such as health education, nutritional therapy, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5525-004 (PPO) with no deductible, featuring a $50 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fittings. Up to two prescription hearing aids are covered per year with a copay of $699 to $999 and no coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5525-004 (PPO), offering no copay and no coinsurance for one routine eye exam (up to $75) and one pair of eyeglasses or contact lenses (up to $100) yearly with prior authorization. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by HumanaChoice H5525-004 (PPO) up to a $1,000 annual limit, offering preventive care like cleanings and exams with no copay and no coinsurance. Medicare-covered dental services require a $50 copay and no coinsurance, and restorative services require a $25 copay and no coinsurance, though fluoride, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-004 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs feature coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-004 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5525-004 (PPO) covers durable medical equipment, prosthetics, and medical supplies with 20% coinsurance and no copay. Diabetic supplies are covered with 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H5525-004 (PPO) covers diagnostic and radiological services with prior authorization, offering no coinsurance for diagnostics, no copay for lab services, and a $0 to $90 copay for diagnostic tests. Outpatient X-rays and diagnostic radiology have no copay, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-004 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5525-004 (PPO) with no coinsurance, but in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered, carrying copayments between $15 and $40, and prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5525-004 (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior inpatient hospital stay is not needed, additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
HumanaChoice H5525-004 (PPO) offers partial coverage for other services, which includes acupuncture for a $50 copay and no coinsurance for up to 20 treatments yearly, and chronic illness meals with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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