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HumanaChoice Giveback H5525-035 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5525-035 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5525-035 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5525-035 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5525-035 (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 Giveback H5525-035 (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 Giveback H5525-035 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $117.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $400.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $450.00 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 HumanaChoice Giveback H5525-035 (PPO) prescription drug plan features an annual drug deductible of $450. For Tier 1 preferred generic drugs, you will pay no copay for 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic prescriptions are also highly affordable, starting with no copay for a 3-month supply through preferred mail order or a low $5 copay for a 1-month supply at standard pharmacies. For Tier 3 preferred brand drugs, the plan features a $47 copay for a 1-month supply at standard pharmacies and mail order services. More expensive medications in Tier 4 and Tier 5 require coinsurance instead of copays, with non-preferred drugs costing 40% coinsurance and specialty tier drugs costing 27% coinsurance.
Additional Benefits
The HumanaChoice Giveback H5525-035 (PPO) plan provides comprehensive medical coverage with many essential services available at no cost to the member. You will pay no copay for primary care visits, routine dental care, routine hearing exams, and annual physicals. For specialized medical services, there is a $35 copay for specialists and a $375 daily copay for the first several days of inpatient hospital stays, with no copay required for subsequent days. Emergency services are covered with a $115 copay, which is waived upon hospital admission, while urgent care visits require a $40 copay. Additionally, the plan features no copay for home health services and covers durable medical equipment with a 15% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice Giveback H5525-035 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 7 for acute care and days 1 through 5 for psychiatric care, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by HumanaChoice Giveback H5525-035 (PPO) with no coinsurance, including no copay for ambulatory surgical center and blood services. Patients will pay a copay of $0 to $450 for outpatient hospital services, $375 per stay for observation services, and $35 per session for outpatient substance abuse services.
Partial Hospitalization See details
HumanaChoice Giveback H5525-035 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5525-035 (PPO) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. For transportation services, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
HumanaChoice Giveback H5525-035 (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
HumanaChoice Giveback H5525-035 (PPO) features primary care physician services with no copay and no coinsurance, while specialist, mental health, and psychiatric services require a $35 copay and no coinsurance. Physical and occupational therapies are covered with a $25 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Giveback H5525-035 (PPO) preventive services are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, and memory fitness. Not covered services 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 benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, remote access, safety modifications, and counseling.
Hearing Services See details
Hearing services covered by the HumanaChoice Giveback H5525-035 (PPO) plan include routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H5525-035 (PPO) offers partially covered vision services with no deductibles, no coinsurance, and copays ranging from $0 to $35 for eye exams and no copay for eyewear. Covered benefits include one routine eye exam (up to $75 annually) and one pair of eyeglasses or contact lenses (up to $150 annually); however, other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5525-035 (PPO) features partially covered dental services, offering Medicare-covered dental care for a $35 copay and no coinsurance, alongside preventive and comprehensive services with no copay and no coinsurance. While routine cleanings, exams, and restorative treatments are covered, this plan does not cover fluoride treatments, implants, maxillofacial prosthetics, or orthodontics.
Home Infusion bundled Services See details
HumanaChoice Giveback H5525-035 (PPO) covers Home Infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice Giveback H5525-035 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to access this covered benefit.
Medical Equipment See details
HumanaChoice Giveback H5525-035 (PPO) covers medical equipment, featuring durable medical equipment with a 15% coinsurance and no copay, and 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 or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5525-035 (PPO) covers diagnostic and radiological services, with prior authorization required for many of these services. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $120 copay for procedures and tests. Radiological services include outpatient X-rays with no copay, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $35 copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice Giveback H5525-035 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by the HumanaChoice Giveback H5525-035 (PPO) plan with no coinsurance, but prior authorization is required. While some services are covered, specific programs such as cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and SET for PAD services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5525-035 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice Giveback H5525-035 (PPO) partially covers other services, offering acupuncture with a $35 copay and no coinsurance for up to 20 treatments per year, and meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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