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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 2026, 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 2026.
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 $129.00. 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 $615.00 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 $13900.00 (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 $13900.00 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 features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, beneficiaries pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a 1-month supply at standard pharmacies, or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply across standard pharmacies and mail order services. Higher-tier medications require coinsurance instead of copays, with Tier 4 non-preferred drugs requiring 43% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. Understanding these tier costs and the annual deductible can help you determine your overall out-of-pocket expenses with this Medicare PPO plan.
Additional Benefits
The Humana Full Access H5525-034 (PPO) plan offers robust coverage with no copay and no coinsurance for inpatient acute hospital stays, primary care visits, specialist consultations, and home health services. Outpatient hospital services feature no coinsurance and a copay ranging from no copay up to $450, while emergency room visits require a $115 copay which is waived if you are admitted. For specialized care, psychiatric hospital stays require a $350 copay per stay, and skilled nursing facility stays have no copay for the first 20 days followed by a $218 daily copay. This plan also includes key supplemental benefits, providing preventive dental, routine vision, and basic hearing exams with no copay and no coinsurance. Prescription hearing aids are partially covered with copays between $699 and $999, while dental restorative services require a 30% to 40% coinsurance. Additionally, members pay no copay and a 20% coinsurance for durable medical equipment and dialysis services, while Medicare Part B chemotherapy and radiation drugs require up to a 20% coinsurance.
Inpatient Hospital See details
Humana Full Access H5525-034 (PPO) covers inpatient acute hospital stays with no copay, no coinsurance, and unlimited additional days, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are covered with a $350 copay per stay and no coinsurance, but additional days and non-Medicare-covered stays are excluded.
Outpatient Services See details
Humana Full Access H5525-034 (PPO) covers outpatient services with no coinsurance and no copays for ambulatory surgical center services, observation services, substance abuse sessions, and blood services. Outpatient hospital services are covered with no coinsurance and a copay ranging from $0 to $450, with prior authorization required for most services.
Partial Hospitalization See details
Humana Full Access H5525-034 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Full Access H5525-034 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Full Access H5525-034 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $115 copay and no coinsurance.
Primary Care See details
Humana Full Access H5525-034 (PPO) covers primary care, specialist, mental health, and therapy services with no copay and no coinsurance, while telehealth services feature a $0 to $40 copay and no coinsurance. Podiatry services are not covered, and although some chiropractic services are covered with a $15 copay and no coinsurance, routine and other chiropractic services are not covered.
Preventive Services See details
Humana Full Access H5525-034 (PPO) preventive services are covered with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings like glaucoma and diabetes self-management. While a memory fitness benefit is included at no cost, other supplemental preventive services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Humana Full Access H5525-034 (PPO), offering Medicare-covered exams, one annual routine exam, and unlimited fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two aids per year, though OTC, inner ear, outer ear, and over the ear devices are not covered.
Vision Services See details
Vision services are partially covered by Humana Full Access H5525-034 (PPO) with no copay and no coinsurance for routine eye exams and select eyewear, though prior authorization is required. The plan covers one routine eye exam up to $75 annually and contact lenses or eyeglasses up to $100 annually, but other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Full Access H5525-034 (PPO) partially covers dental services up to a $2,000 yearly maximum, offering no copay and no coinsurance for most preventive, diagnostic, and surgical services, while restorative and fixed prosthodontics have no copay and 30% to 40% coinsurance. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Full Access H5525-034 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Full Access H5525-034 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Full Access H5525-034 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Full Access H5525-034 (PPO) with prior authorization required. Members pay no copay and no coinsurance for lab services, a $0 to $40 copay with no coinsurance for diagnostic procedures, no copay for outpatient X-rays, and a 20% coinsurance with no copay for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by Humana Full Access H5525-034 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Full Access H5525-034 (PPO) covers some cardiac rehabilitation services with no copay, no coinsurance, and prior authorization required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Full Access H5525-034 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Full Access H5525-034 (PPO) partially covers other services, offering acupuncture (up to 20 treatments per year) and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required. Over-the-counter (OTC) items are not covered under this benefit.
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