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HumanaChoice H5525-017 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-017 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-017 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-017 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-017 (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 H5525-017 (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 H5525-017 (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 has a $120.00 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 $6300.00 (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 $6300.00 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 H5525-017 (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 the pharmacy you use. For example, for preferred generic drugs, you will pay a $5 copay at preferred mail order pharmacies, and a $20 copay at standard mail order pharmacies. You will pay 40% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5525-017 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $325 copay, while outpatient services have copays ranging from $0 to $400. Emergency services will cost you a $125 copay, and primary care visits have no copay. The plan also includes coverage for preventive services, hearing, vision, and dental. Many preventive services, like annual physical exams, have no copay. Dental services have a $2,000 annual maximum, but some procedures require coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $325 copay per admission or stay. Additional Days for Inpatient Hospital-Acute has no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $400, observation services with a $325 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $30 and $80 for individual or group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-017 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-017 (PPO) plan. Ground and air ambulance services have a $315 copay, while transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year, using a taxi, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice H5525-017 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, with no coinsurance.
Primary Care See details
The HumanaChoice H5525-017 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a copay between $20 and $30. Physician specialist services have a $15 copay, while mental health specialty services, psychiatric services, and opioid treatment program services have copays between $30 and $80. Physical therapy and speech-language pathology services have a copay between $20 and $30. Additional telehealth benefits are covered with a copay between $0 and $55. Podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional preventive services. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all have no copay.
Hearing Services See details
The HumanaChoice H5525-017 (PPO) plan covers hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. The plan also covers OTC hearing aids with a maximum benefit of $20 every month, but prescription hearing aids - inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
The HumanaChoice H5525-017 (PPO) plan covers vision services, including eye exams with a copay between $0 and $15, 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 H5525-017 (PPO) covers dental services with a $2,000 annual maximum, including Medicare dental services with a $15 copay. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (fixed) are covered with no copay, but with a 30% - 40% coinsurance. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
The HumanaChoice H5525-017 (PPO) plan covers Durable Medical Equipment with a 20% coinsurance, and also covers Prosthetic Devices, Medical Supplies, and Diabetic Equipment. Diabetic Supplies have a 10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a copay between $0 and $105, lab services with no copay, diagnostic radiological services with a copay up to $325, therapeutic radiological services with a copay up to $30 and 20% coinsurance, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-017 (PPO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
HumanaChoice H5525-017 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5525-017 (PPO) plan, requiring prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214, while additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under "Other Services," acupuncture is covered with a $15 copay per visit, up to 20 treatments per year, and over-the-counter (OTC) items are covered with a monthly maximum of $20. Meal benefits are also covered with no copay, and prior authorization is required for both acupuncture and the meal benefit. However, services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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