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HumanaChoice H5525-006 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-006 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-006 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-006 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in South Central Pennsylvania area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-006 (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 H5525-006 (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 H5525-006 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. 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 $6700.00 (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 $6700.00 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 H5525-006 (PPO) Medicare prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply at standard pharmacies and featuring no copay for a three-month supply via preferred mail order. For Tier 3 preferred brand drugs, copays start at $47 for a one-month supply across standard pharmacies and mail order options. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. These structured costs help you easily estimate your monthly and long-term prescription expenses with this PPO plan.
Additional Benefits
HumanaChoice H5525-006 (PPO) offers affordable coverage for core medical services, featuring no copay and no coinsurance for primary care visits and preventive care. Specialist visits require a $40 copay, while inpatient hospital stays incur a $350 copay per day for days 1 through 7, with no copay for subsequent days. Emergency room visits carry a $130 copay, which is waived upon admission, and urgent care services are available for a $50 copay. For extra health needs, the plan provides dental coverage up to a $1,000 annual limit, featuring no copay for preventive dental care and routine vision and hearing exams. Durable medical equipment and dialysis services require no copay but carry a 10% to 20% and 20% coinsurance, respectively. If you require skilled nursing facility care, you will pay a $10 daily copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice H5525-006 (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $350 copay for days 1 to 7 and no copay for days 8 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, requiring a $320 copay for days 1 to 6 and no copay for days 7 to 90, but additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5525-006 (PPO) with no coinsurance, featuring a copay of $0 to $510 for hospital services and $350 per stay for observation services. Ambulatory surgical center and outpatient blood services are fully covered with no copays or coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice H5525-006 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5525-006 (PPO) covers 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 H5525-006 (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require 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 H5525-006 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $40 copay and no coinsurance. Therapy, mental health, and telehealth services are also covered with copays ranging from $0 to $50 and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice H5525-006 (PPO) with no copay and no coinsurance, which includes annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs, and a memory fitness benefit. However, additional preventive services are only partially covered, and the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home/bathroom safety, and counseling.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5525-006 (PPO), which features a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Covered prescription hearing aids require a copay of $499 to $799 and no coinsurance, though 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 H5525-006 (PPO) with no deductibles, no coinsurance, and copays ranging from no copay to $40 for exams and no copay for eyewear. While routine eye exams, contact lenses, and eyeglasses are covered up to annual limits, 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 H5525-006 (PPO) up to a $1,000 annual maximum, featuring no copay and no coinsurance for preventive care, a $25 copay and no coinsurance for restorative services, and a $40 copay and no coinsurance for Medicare-covered dental. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-006 (PPO) covers Home Infusion bundled Services with no copay, although prior authorization is required. Medicare Part B chemotherapy and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5525-006 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5525-006 (PPO) with prior authorization, featuring a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies have a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5525-006 (PPO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay ranging from $0 to $105. Covered radiological services include outpatient X-rays with no copay, diagnostic radiology with a $0 minimum copay, and therapeutic radiology with a minimum 20% coinsurance and $40 copay.
Home Health Services See details
HumanaChoice H5525-006 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5525-006 (PPO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, cardiac rehabilitation and intensive cardiac rehabilitation (each requiring a $40 copay), as well as pulmonary rehabilitation and supervised exercise therapy for peripheral artery disease (each requiring a $10 copay), are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-006 (PPO) covers Skilled Nursing Facility (SNF) services 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, though a prior three-day inpatient hospital stay is not, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5525-006 (PPO) partially covers other services, offering acupuncture with a $40.00 copay and no coinsurance for up to 20 treatments per year, as well as chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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