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HumanaChoice H5525-005 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-005 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-005 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-005 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Pennsylvania & West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-005 (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 H5525-005 (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 H5525-005 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 $300.00 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 $11300.00 (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 $11300.00 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 H5525-005 (PPO) plan has a $300 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you may pay a $15 copay for preferred generic drugs at a standard pharmacy, or 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-005 (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with varying copays, and outpatient services with copays ranging from $0 to $635. This plan also covers ambulance services, emergency services, and primary care physician visits with a $5 copay, and offers preventive services, such as annual physical exams, with no copay. Additional benefits include coverage for hearing exams, vision care, and dental services with varying copays. The plan also provides coverage for home health services, skilled nursing facilities, and diagnostic services with associated copays and coinsurance. This plan also includes coverage for ambulance services, emergency services, and primary care physician visits with a $5 copay, and offers preventive services, such as annual physical exams, with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits for HumanaChoice H5525-005 (PPO) include Inpatient Hospital-Acute, with a copay of $379 for days 1-6 and no copay for days 7-90, and Inpatient Hospital Psychiatric, with a copay of $387 for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered stay and Upgrades for Inpatient Hospital-Acute are not covered, as are Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay of $0-$635, Observation Services with a copay of $379, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay of $40-$90 for individual and group sessions, and Outpatient Blood Services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-005 (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-005 (PPO) plan. Ground and Air Ambulance Services have a copay of $315, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under this plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $110 copay; there is no coinsurance for any of these services.
Primary Care See details
The HumanaChoice H5525-005 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy services with a $20-$35 copay, physician specialist services with a $40 copay, mental health specialty services with a $40 copay, physical therapy and speech-language pathology services with a $20-$35 copay, additional telehealth benefits with a $0-$45 copay, and opioid treatment program services with a $40-$90 copay. This plan does not cover podiatry services and routine chiropractic care.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, as well as additional services with no copay, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a Welcome Visit; however, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. The Fitness Benefit is covered with no copay.
Hearing Services See details
The HumanaChoice H5525-005 (PPO) plan covers hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $499 and $799, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are covered up to $45 every three months.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$40, and eyewear, including contact lenses and eyeglasses (lenses and frames), with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $40 copay for Medicare dental services, no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services, and a $25 copay for restorative services. Fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. There is a $1,000 maximum plan benefit coverage per year for in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5525-005 (PPO), with a coinsurance of 20%. Prior authorization is required for coverage.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 15% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, Diabetic Supplies with 10% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $105, lab services with no copay, and outpatient X-ray services with a $5 copay. Diagnostic radiological services have a copay up to $300 and therapeutic radiological services have a copay up to $40 and coinsurance up to 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-005 (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 under the HumanaChoice H5525-005 (PPO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5525-005 (PPO) plan, but require prior authorization. There is 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 includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $40 copay, and the meal benefit has no copay. OTC items are covered up to $45 every three months.
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