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HumanaChoice H5525-030 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-030 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-030 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-030 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Ohio & N KY. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-030 (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 H5525-030 (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 H5525-030 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $85.00. 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. 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 $3950.00 (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 $3950.00 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 H5525-030 (PPO) Medicare plan features an annual prescription drug deductible of $350. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $8 for a 1-month supply at standard pharmacies and preferred mail order, with the added benefit of no copay on 3-month supplies ordered through preferred mail. Tier 3 preferred brand drugs have a standard 1-month copay of $47, which drops to a slightly lower $131 for a 3-month supply if you use preferred mail order. For higher-tier prescriptions, you will pay a coinsurance percentage, which is 42% for Tier 4 non-preferred drugs and 29% for Tier 5 specialty drugs. This structured coverage ensures predictable copays for common medications while utilizing coinsurance for specialized prescriptions.
Additional Benefits
The HumanaChoice H5525-030 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive screenings, and home health services. For specialist visits, outpatient care, and emergency room services, members will pay predictable copays ranging from $10 to $140 with no coinsurance. Inpatient hospital stays require a $360 daily copay for the first seven days, followed by no copay for days 8 through 90. This plan also includes valuable dental, vision, and hearing benefits, featuring no copay for preventive dental care, routine eye exams, and routine hearing evaluations. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance, while prescription hearing aids require a copay of $699 to $999. Additional benefits like diagnostic lab work and chronic illness meal services are also available with no copay.
Inpatient Hospital See details
HumanaChoice H5525-030 (PPO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $360 daily copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute stays are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HumanaChoice H5525-030 (PPO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $360, observation services have a $360 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5525-030 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5525-030 (PPO) covers ground and air ambulance services with a $315 copay per service and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
HumanaChoice H5525-030 (PPO) covers emergency services with a $140 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are all covered with a $140 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-030 (PPO) covers primary care physician services with no copay and telehealth benefits with copays ranging from no copay up to $65, both with no coinsurance. Specialist visits, physical and occupational therapies, mental health, and psychiatric services are also covered with no coinsurance and copays ranging from $10 to $40, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under HumanaChoice H5525-030 (PPO) are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs, and memory fitness benefits. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home modifications, and counseling.
Hearing Services See details
HumanaChoice H5525-030 (PPO) provides partially covered hearing services, including annual routine exams and unlimited fitting evaluations with no copay and no coinsurance, alongside Medicare-covered exams for a $40 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $699 to $999 and no coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5525-030 (PPO) offers partially covered vision services with no deductibles and no coinsurance, featuring a $0 to $40 copay for eye exams (no copay for one routine exam up to a $75 annual limit). Covered eyewear, including one pair of contact lenses or eyeglasses, has no copay up to a $100 annual limit, but other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-030 (PPO) dental services are partially covered up to a $1,000 annual limit, featuring no copay and no coinsurance for preventive services, a $40 copay and no coinsurance for Medicare-covered dental, and a $25 copay and no coinsurance for restorative care. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-030 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
The HumanaChoice H5525-030 (PPO) plan covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5525-030 (PPO), with durable medical equipment, prosthetics, and medical supplies requiring 20% coinsurance and no copay. Diabetic supplies are covered with 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5525-030 (PPO) covers diagnostic and radiological services with prior authorization, providing lab services with no copay and no coinsurance, and diagnostic tests with no coinsurance and a copay ranging from $0 to $90. Outpatient X-rays and diagnostic radiological services feature no copay (though X-rays require coinsurance), while therapeutic radiological services require a minimum $30 copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the HumanaChoice H5525-030 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5525-030 (PPO) with no coinsurance and require prior authorization, though in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice H5525-030 (PPO) with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $214 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5525-030 (PPO), including acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and meal benefits for chronic illness with no copay and no coinsurance. Prior authorization is required for both of these covered benefits, while over-the-counter (OTC) items are not covered.
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