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HumanaChoice H5525-027 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-027 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-027 (PPO) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
HumanaChoice H5525-027 (PPO) is a PPO plan offered by Humana Inc. available for the 2025 plan year to people living in Select Counties in MT. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-027 (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 H5525-027 (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 H5525-027 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $66.00. 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 $300.00 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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $8950.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 H5525-027 (PPO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your medications depending on the drug tier and the pharmacy you use. For example, you will pay a $12 copay for preferred generic drugs at a standard or preferred mail pharmacy. For preferred brand drugs, you'll pay 50% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice H5525-027 (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with copays, and outpatient services with copays ranging from $0 to $500. This plan also covers emergency services, primary care, preventive services, and vision services with varying copays. Some services, like ambulance, hearing, and dental services, have specific copays, while others, such as home health and skilled nursing facility services, have no copays or have copays depending on the service.
Inpatient Hospital See details
The HumanaChoice H5525-027 (PPO) plan covers inpatient hospital stays, including acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $530 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $450 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $500, observation services with a $530 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay between $40 and $90 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5525-027 (PPO) plan, with a copay of $85.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services for HumanaChoice H5525-027 (PPO) includes coverage for ground and air ambulance services, with no coinsurance. Ground ambulance services have a $315 copay, while air ambulance services have a $1250 copay; however, 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 H5525-027 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency, Urgent, and Transportation services each have a $125 copay.
Primary Care See details
The HumanaChoice H5525-027 (PPO) plan covers primary care physician services with a $15 copay, chiropractic services with a $20 copay (prior authorization required), and occupational therapy services with a $35 copay (prior authorization required). It also covers physician specialist services with a $50 copay, mental health specialty services, psychiatric services, and physical therapy/speech-language pathology services with a $35 copay (prior authorization required). Additional telehealth benefits are covered with a copay between $0 and $55, and opioid treatment program services are covered with a copay between $40 and $90 (prior authorization required).
Preventive Services See details
The HumanaChoice H5525-027 (PPO) plan covers preventive services, including annual physical exams with no copay. Additional preventive services, including Fitness Benefit, Kidney Disease Education Services, and Other Preventive Services, are covered, though some services may have a copay. Several services, including Health Education and Home and Bathroom Safety Devices and Modifications, are not covered.
Hearing Services See details
Hearing Services are covered by the HumanaChoice H5525-027 (PPO) plan, including hearing exams with a $50 copay, but routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered under the HumanaChoice H5525-027 (PPO) plan, with eye exams costing between $0 and $50. Eyewear is covered with no copay, but contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5525-027 (PPO) plan covers Medicare dental services with a $50 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, and adjunctive general services with no copay. However, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
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%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), is covered with a 15% coinsurance and requires authorization. Prosthetics/Medical Supplies have a 15% coinsurance, and Diabetic Equipment has coinsurance and copays, with specific costs varying by service.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic and radiological services, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $90, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $500, Therapeutic Radiological Services have a 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 H5525-027 (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 under the HumanaChoice H5525-027 (PPO) plan, but the specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5525-027 (PPO) plan, but require prior authorization. You will have no copay for days 1-20 and days 66-100, but a $214 copay for days 21-65.
Other Services See details
The HumanaChoice H5525-027 (PPO) plan covers acupuncture with a $50 copay and a limit of 20 treatments per year, and meal benefits with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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