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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 2025, 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 2025.
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 $38.00. 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 $60.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $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) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, for a standard pharmacy, you will pay a $15 copay for preferred generic drugs, a $47 copay for standard generic drugs, and 50% coinsurance for preferred brand drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-006 (PPO) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay, with outpatient services having copays depending on the service. Emergency and urgent care services have copays, and primary care visits have a $5 copay, while specialist visits are $40. Preventive services, including annual physical exams, are covered with no copay. The plan also includes coverage for hearing, vision, and dental services, with copays for exams and certain procedures. Additional benefits include ambulance services, home health, medical equipment, and skilled nursing facility stays, each with their own cost-sharing.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-7, and no copay for days 8-90, with additional days 91-999 having no copay; however, Non-Medicare-covered stay and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, you pay a $320 copay for days 1-6, and no copay for days 7-90, but Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $485, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $40 and $90 for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5525-006 (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $315 copay, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice H5525-006 (PPO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency, Urgent, and Transportation services each have a $125 copay with no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a $5 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $20-$40 copay, Physician Specialist Services with a $40 copay, and Mental Health Specialty Services, with individual sessions having a $40 copay and group sessions having a $40 copay. Other Health Care Professional services have a $5-$40 copay, Psychiatric Services have individual sessions with a $40 copay and group sessions with a $40 copay, Physical Therapy and Speech-Language Pathology Services have a $20-$40 copay, Additional Telehealth Benefits have a $0-$55 copay, and Opioid Treatment Program Services have a $40-$90 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice H5525-006 (PPO) plan covers preventive services with no copay for annual physical exams. Additional preventive services, including fitness benefits, are covered, but other services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
The HumanaChoice H5525-006 (PPO) plan covers hearing exams with a $40 copay and routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $799 for two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The HumanaChoice H5525-006 (PPO) plan covers vision services, including eye exams with a copay of $0-$40 and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-006 (PPO) offers dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, and restorative services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay, while restorative services have a $25 copay. Fluoride treatment, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are not covered.
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 with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-006 (PPO) plan, with a coinsurance between 20% and 20%. Prior authorization is required for this service.
Medical Equipment See details
Medical Equipment benefits are covered by the HumanaChoice H5525-006 (PPO) plan, including Durable Medical Equipment with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying cost-sharing. Diabetic Supplies have a 10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The HumanaChoice H5525-006 (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $105, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have a copay up to $40 and 20% coinsurance, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-006 (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice H5525-006 (PPO) plan, but the specific cost-sharing details for this benefit are not provided. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay.
Other Services See details
Other Services for HumanaChoice H5525-006 (PPO) includes acupuncture with a $40 copay, and a meal benefit with no copay. Over-the-counter items, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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