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Humana Full Access H5525-034 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5525-034 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5525-034 (PPO) in 2025, please refer to our full plan details page.
Humana Full Access H5525-034 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Wilmington Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Full Access H5525-034 (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 Humana Full Access H5525-034 (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 Humana Full Access H5525-034 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $145.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 Humana Full Access H5525-034 (PPO) plan has a $350 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, if you use a standard pharmacy, you will pay a $12 copay for preferred generic drugs, and a $47 copay for standard generic drugs. You will pay 50% coinsurance for preferred brand drugs, and 28% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Humana Full Access H5525-034 (PPO) plan offers a wide range of benefits with varying costs. Many services have no copay, including inpatient hospital-acute, outpatient substance abuse, primary care visits, preventive services, hearing exams, eye exams, and dental cleanings. Emergency services have a $110 copay, while ambulance services have a $315 copay. The plan also covers services such as home health, skilled nursing, and dialysis services with no copay or varying coinsurance amounts. Other benefits include coverage for vision, hearing, and dental services. The plan does not cover certain services, such as routine chiropractic care, podiatry services, and many other services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with no copay and Additional Days for Inpatient Hospital-Acute with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric has a $350 copay, while 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 $450, observation services with no copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with no copay for both individual and group sessions, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Full Access H5525-034 (PPO) plan. There is no copay for this benefit, but prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Full Access H5525-034 (PPO) plan. Ground and Air Ambulance Services have a copay of $315, 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 Humana Full Access H5525-034 (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, while Urgently Needed Services have no copay.
Primary Care See details
The Humana Full Access H5525-034 (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Individual and group sessions for mental health and psychiatric services have no copay. Occupational therapy services, other health care professional services, and opioid treatment program services have a $0 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered preventive services with no copay, and an annual physical exam with no copay. Other preventive services, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services includes coverage for hearing exams with no copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aids with no copay. Prescription Hearing Aids (all types) have a copay between $699 and $999, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Humana Full Access H5525-034 (PPO) plan covers vision services, including routine eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers one routine eye exam and one pair of contact lenses or eyeglasses per year, with a combined maximum of $100 for eyewear, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Full Access H5525-034 (PPO) plan covers dental services with a $2,000 maximum benefit per year, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. The plan does not cover fluoride treatments, prosthodontics (removable), maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. You may have to pay a $35 copay for Medicare Part B Insulin Drugs, with coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, with no copay. Diabetic Supplies have a 10-20% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of at most $325.00, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5525-034 (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
Cardiac Rehabilitation Services are covered under the Humana Full Access H5525-034 (PPO) plan, but the plan does not cover the services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Full Access H5525-034 (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100, with no coinsurance.
Other Services See details
Other Services includes acupuncture and a meal benefit. Acupuncture has no copay, and the plan covers up to 20 treatments per year, but requires prior authorization. The meal benefit also has no copay, and is provided for a chronic illness. Other services such as over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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