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HumanaChoice H5525-026 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-026 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-026 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-026 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-026 (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 H5525-026 (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 H5525-026 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $90.00. 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 $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $350.00 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 $14000.00 (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 $14000.00 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 H5525-026 (PPO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for a 30-day supply, you'll pay a $12 copay at a standard pharmacy for preferred generics, and 40% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-026 (PPO) plan provides a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays. You'll pay a copay for services like hospital stays, emergency care, and specialist visits. Many preventive services and primary care visits are covered with no copay, and the plan also offers coverage for hearing, vision, and dental services, though some limitations apply. The plan includes coverage for ambulance services, diagnostic services, and home health services. It also covers medical equipment and offers benefits for home infusion and dialysis services. However, services like cardiac rehabilitation, certain dental procedures, and additional hours of home health care are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $475 copay for days 1-5, and no copay for days 6-90, and no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $475 copay for days 1-4, and no copay for days 5-90, and no coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $450, observation services have a $475 copay, ASC services have no copay, individual and group outpatient substance abuse sessions have a copay between $45 and $100, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-026 (PPO) plan and requires prior authorization. The copay for this service is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-026 (PPO) plan. Ground and air ambulance services have a $315 copay, and there is 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 H5525-026 (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice H5525-026 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a $45 copay, mental health specialty services with a $45 copay, and physical therapy and speech-language pathology services with a $25 copay. Additionally, the plan covers additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a copay between $45 and $100. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5525-026 (PPO) plan covers preventive services with no copay for services like annual physical exams, Medicare-covered preventive services, and glaucoma screenings. Other preventive services, such as Diabetes Self-Management Training and Barium Enemas, are covered with no copay. However, several preventive services are not covered, including health education, in-home safety assessments, and medical nutrition therapy.
Hearing Services See details
Hearing Services includes hearing exams with a $45 copay, routine hearing exams with no copay for one visit every year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999 for two visits every year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5525-026 (PPO) plan covers vision services, including eye exams with a copay between $0 and $45, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5525-026 (PPO) plan covers Medicare Dental Services with a $45 copay, and offers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services with no copay. Fluoride Treatment, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered. Adjunctive General Services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the HumanaChoice H5525-026 (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-026 (PPO) plan, but prior authorization is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the HumanaChoice H5525-026 (PPO) plan, including Durable Medical Equipment with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered with a coinsurance and copay, with specific details available.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay ranging from $0 to $120 for diagnostic procedures/tests and no copay for lab services. Outpatient X-ray services have no copay, while diagnostic radiological services have a copay of at most $325, and therapeutic radiological services have a copay of at most $45 and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-026 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H5525-026 (PPO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services require prior authorization and are covered by the HumanaChoice H5525-026 (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for acupuncture with a $45 copay, and a meal benefit with no copay; however, over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered. Acupuncture is limited to 20 treatments per year.
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