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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 2026, 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 2026.
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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $7.00. 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 $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) Medicare prescription drug plan features an annual drug deductible of $220. Under this plan, Tier 1 preferred generic drugs have no copay when filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs are available for a $5 copay for a one-month supply at standard pharmacies, or with no copay for a three-month supply when using preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply at standard pharmacies and mail-order services. Tier 4 non-preferred drugs require a 50% coinsurance for both one-month and three-month supplies. Finally, Tier 5 specialty medications require a 30% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The HumanaChoice H5525-008 (PPO) plan offers affordable access to essential medical care, featuring no copay for primary care visits and preventive services, while specialist visits require a 60 dollar copay. For hospital stays, inpatient care requires a 470 dollar daily copay for the first few days with no coinsurance, and emergency room visits carry a 130 dollar copay. Outpatient services feature copays ranging from no copay to 470 dollars with no coinsurance, ensuring predictable costs for most outpatient medical procedures. Routine dental, vision, and hearing exams are covered with no copay and no coinsurance, though annual benefit limits and copays apply for restorative dental treatments and prescription hearing aids. Durable medical equipment and dialysis services require a 20 percent coinsurance with no copay, while home health services are covered with no copay or coinsurance. Skilled nursing facility care is also available with no coinsurance, utilizing a daily copay structure of 10 dollars for the first 20 days and 218 dollars for days 21 through 100.
Inpatient Hospital See details
HumanaChoice H5525-008 (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $470 daily copay for days 1 through 5 of acute stays and days 1 through 4 of psychiatric stays, with no copay for subsequent days. Room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5525-008 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Medicare-covered outpatient hospital services have a copay of $0 to $470, observation services require a $470 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
HumanaChoice H5525-008 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5525-008 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services are not covered under this plan.
Emergency Services See details
HumanaChoice H5525-008 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. 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 H5525-008 (PPO) primary care physician services are covered with no copay and no coinsurance, while specialist visits require a $60 copay and no coinsurance. Additional services like therapy, mental health, and podiatry have copays ranging from $35 to $60 with no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
HumanaChoice H5525-008 (PPO) covers preventive services, including annual physical exams, kidney disease education, and memory fitness, with no copay and no coinsurance. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5525-008 (PPO) hearing services are covered with no coinsurance, featuring a $60 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with no coinsurance and a $499 to $1,099 copay for up to two devices per year, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice H5525-008 (PPO) vision services are partially covered, offering one annual routine eye exam and eyewear (contacts or complete eyeglasses) with no copay, no coinsurance, and no deductible. Annual maximum benefits are limited to $75 for exams and $100 for eyewear, while other eye exams, individual lenses or frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5525-008 (PPO) with a yearly maximum benefit of $1,000 for both in- and out-of-network care. Covered preventive, diagnostic, and adjunctive services have no copay and no coinsurance, while Medicare-covered dental requires a $60 copay and restorative services require a $25 copay, both with no coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-008 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, insulin, and other drugs are covered with coinsurance ranging from no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
HumanaChoice H5525-008 (PPO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HumanaChoice H5525-008 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies have a 10% to 20% coinsurance and no copay, while diabetic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H5525-008 (PPO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay between $0 and $105. Covered radiological services require prior authorization and include outpatient X-rays with no copay, diagnostic radiology starting at a $0 copay, and therapeutic radiology requiring a minimum 20% coinsurance and a minimum $45 copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5525-008 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5525-008 (PPO) notes that some services are covered for Cardiac Rehabilitation Services with no coinsurance, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These services require prior authorization and have copayments ranging from $10.00 to $15.00.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-008 (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, and while a prior three-day inpatient hospital stay is not required, additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5525-008 (PPO) partially covers other services, offering acupuncture for a $60 copay and no coinsurance for up to 20 treatments per year. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, while other unspecified services are not covered.
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