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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 2026, 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 2026.
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 $26.00. 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 $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 features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is 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 for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, which can be filled at standard pharmacies or through mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply. Choosing preferred mail order options for your prescriptions can help lower your out-of-pocket costs on this PPO plan.
Additional Benefits
The HumanaChoice H5525-005 (PPO) plan offers robust coverage for everyday healthcare needs, featuring no copays and no coinsurance for primary care visits, home health services, and routine preventive care. Specialists and urgent care visits require a $40 copay, while emergency services are covered with a $115 copay. For major medical events, inpatient acute hospital stays carry a $379 daily copay for the first six days, and outpatient hospital services range from a $0 to $635 copay, both with no coinsurance. Supplemental benefits include dental coverage up to a $1,000 annual limit with no copay for preventive care, and vision coverage offering eyewear with no copay up to a $250 yearly limit. Hearing care features no copay for routine exams and OTC hearing aids, while prescription hearing aids require a copay between $499 and $799. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5525-005 (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $379 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $387 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5525-005 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copays. Outpatient hospital services require a copay of $0 to $635, observation services cost a $379 copay per stay, and individual or group substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice H5525-005 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5525-005 (PPO) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5525-005 (PPO) covers emergency services with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered for a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-005 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, opioid, and telehealth services feature copays ranging from $0 to $40 with no coinsurance, though podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services under the HumanaChoice H5525-005 (PPO) plan are partially covered, offering covered services like annual physical exams, kidney disease education, memory fitness, and select screenings with no copay and no coinsurance. Numerous additional preventive services are not covered, including health education, weight management programs, nutritional/dietary benefits, and in-home safety assessments.
Hearing Services See details
HumanaChoice H5525-005 (PPO) hearing services are covered with no coinsurance, offering routine exams and fitting evaluations for no copay, while Medicare-covered exams require a $40 copay. Prescription hearing aids are partially covered with a copay ranging from $499 to $799 for up to two aids per year, excluding inner ear, outer ear, and over the ear prescription aids. Over-the-counter (OTC) hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
HumanaChoice H5525-005 (PPO) partially covers vision services with no deductibles and no coinsurance, offering eye exams with a $0 to $40 copay and eyewear with no copay up to a $250 annual limit. Other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5525-005 (PPO) up to a $1,000 annual limit, with no copay and no coinsurance for preventive care such as cleanings and exams. Medicare-covered dental services require a $40 copay and restorative services require a $25 copay, both with no coinsurance, while fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5525-005 (PPO) with no copay, though associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance. Covered Medicare Part B insulin requires a $35 copay and 0% to 20% coinsurance, with prior authorization and step therapy applying to certain services.
Dialysis Services See details
Dialysis services are covered under the HumanaChoice H5525-005 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5525-005 (PPO) covers durable medical equipment, prosthetic devices, and medical supplies with a 20% 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.
Diagnostic and Radiological Services See details
HumanaChoice H5525-005 (PPO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic tests with a copay of $0 to $105. Covered radiological services require a minimum $40 copay and 20% coinsurance for therapeutic radiology, while outpatient X-rays have no copay and diagnostic radiology has a minimum $0 copay.
Home Health Services See details
HumanaChoice H5525-005 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HumanaChoice H5525-005 (PPO) with no coinsurance, but only some services are covered as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD are not covered. When covered, these services require prior authorization and a copayment ranging from $10 to $30.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-005 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, but a prior three-day inpatient hospital stay is not needed, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
HumanaChoice H5525-005 (PPO) partially covers other services, featuring acupuncture with a $40 copay and no coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Dual eligible SNPs with highly integrated services are not covered, and prior authorization is required for acupuncture and meal services.
Get Personalized Help from a licensed insurance agent
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