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HumanaChoice H5525-008 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-008 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-008 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-008 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Indiana and Kentucky. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-008 (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 H5525-008 (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 H5525-008 (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 $220.00 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 H5525-008 (PPO) plan has a $220.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $17.00 copay at a standard pharmacy for preferred generic drugs and 45% coinsurance for preferred brand drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-008 (PPO) plan offers a range of benefits with varying costs. You'll pay copays for services like inpatient hospital stays, outpatient services, and doctor visits, with some services having no copay. Emergency services, hearing exams, and vision services are covered with copays as well, and there is also dental coverage. The plan covers preventive services, including an annual physical exam, with no copay. Other benefits include ambulance services, home health services, and medical equipment, with some services requiring a coinsurance payment. The plan also offers coverage for prescription hearing aids and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the HumanaChoice H5525-008 (PPO) plan. For Inpatient Hospital-Acute, you will pay a $470 copay for days 1-5 and no copay for days 6-90, while Additional Days for Inpatient Hospital-Acute has no copay for days 91-999; however, Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $470 copay for days 1-4 and no copay for days 5-90, but Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
The HumanaChoice H5525-008 (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $470, observation services with a $470 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $60 and $85 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5525-008 (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 H5525-008 (PPO) plan, including both ground and air ambulance services, each with a $315 copay and no coinsurance. 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 under the HumanaChoice H5525-008 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
HumanaChoice H5525-008 (PPO) covers primary care physician services with a $15 copay. Chiropractic services have a $20 copay and require prior authorization, while routine chiropractic care is not covered. Occupational therapy services have a $45 copay, and physician specialist services have a $60 copay. Mental health specialty services and psychiatric services have a $60 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $45 copay and require authorization. Additional telehealth benefits have a $0-$60 copay, and opioid treatment program services have a $60-$85 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services, including fitness benefits, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered with no copay. Health education, in-home safety assessment, personal emergency response system, 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 benefit, 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.
Hearing Services See details
Hearing exams are covered with a $60 copay, and routine hearing exams have no copay. Fitting/Evaluation for Hearing Aids has no copay. Prescription Hearing Aids are partially covered, with a copay between $399 and $999 for all types, but Inner Ear, Outer Ear, and Over the Ear hearing aids are not covered. OTC Hearing Aids are covered.
Vision Services See details
The HumanaChoice H5525-008 (PPO) plan covers vision services, including routine eye exams with a copay of $0-$60, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5525-008 (PPO) plan covers dental services including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), and other preventive services with no copay; however, fluoride treatment is not covered. Restorative services have a $25 copay, and adjunctive general services have no copay. Some services require prior authorization. The plan has a maximum benefit of $1,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and a coinsurance between 0% and 20% for all Medicare Part B drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5525-008 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
HumanaChoice H5525-008 (PPO) covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay that ranges from $0 to $105, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $720, Therapeutic Radiological Services have a copay of at most $45 and coinsurance of at least 20%, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-008 (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 not covered by the HumanaChoice H5525-008 (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-008 (PPO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered SNF stays are not covered.
Other Services See details
The HumanaChoice H5525-008 (PPO) plan covers acupuncture with a $60 copay, up to 20 treatments per year, and also covers over-the-counter items, with a maximum benefit of $30 every three months. The plan also covers a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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