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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 2025, 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 Select Counties in North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $107.00. 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 $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 HumanaChoice Giveback H5525-035 (PPO) plan has a $450 deductible. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy. In the initial coverage phase, you will pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy, while standard generic drugs have a $47 copay. Preferred and non-preferred brand drugs have a coinsurance of 43% and 27% respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice Giveback H5525-035 (PPO) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $450, and emergency services with a $110 copay. Primary care visits have no copay, while specialist visits have a $50 copay. Preventive services, hearing exams, and vision services are also covered. Additional benefits include dental services with a $50 copay for Medicare services, home infusion with copays and coinsurance, and medical equipment with coinsurance. The plan covers home health services with no copay, and skilled nursing facility stays with a $0 copay for the first 20 days. Other covered services include acupuncture and a meal benefit, but it does not cover some services such as cardiac rehabilitation, and some dental, vision, and hearing services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $460 copay for days 1-5, and no copay for days 6-90, while additional days from 91-999 have no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $460 copay for days 1-4, and no copay for days 5-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $450, observation services with a $460 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a copay between $45 and $100 for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $315 copay for both Ground and Air Ambulance Services and no coinsurance. Transportation Services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice Giveback H5525-035 (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance.
Primary Care See details
The HumanaChoice Giveback H5525-035 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. Physician specialist services have a $50 copay, and physical therapy and speech-language pathology services have a $25 copay. The plan also covers mental health and psychiatric services with a $45 copay for individual and group sessions.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and annual physical exams with no copay. Additional preventive services, including Health Education, In-Home Safety Assessment, and others, are not covered.
Hearing Services See details
The HumanaChoice Giveback H5525-035 (PPO) plan covers hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $699 and $999 depending on the type of hearing aid, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice Giveback H5525-035 (PPO) plan covers eye exams with a copay of $0-$50, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice Giveback H5525-035 (PPO) plan covers Medicare Dental Services with a $50 copay, and other services like oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), and other preventive services with no copay. 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 9% coinsurance and Prosthetics/Medical Supplies with a 9% coinsurance, along with Diabetic Equipment, which has a coinsurance and copay. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Lab services have no copay, while diagnostic procedures/tests have a maximum copay of $120.00. Therapeutic Radiological Services have a maximum copay of $50 and a minimum coinsurance of 20%, while Diagnostic Radiological Services have a maximum copay of $325.00. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Giveback H5525-035 (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
HumanaChoice Giveback H5525-035 (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for covered services, but no specific copay or coinsurance information is provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice Giveback H5525-035 (PPO) plan, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays are not covered.
Other Services See details
The HumanaChoice Giveback H5525-035 (PPO) plan covers acupuncture with a $50 copay, and a meal benefit with no copay. The plan does not cover 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.
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