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HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5525-036 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice SNP-DE H5525-036 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Greater North Carolina Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5525-036 (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice SNP-DE H5525-036 (PPO D-SNP).
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 SNP-DE H5525-036 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.20. 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 $590.00 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 SNP-DE H5525-036 (PPO D-SNP) plan has a deductible of $590.00. Once you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), also known as "Extra Help". Those with LIS will pay $51.20 for Part D.
Additional Benefits
The HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay of $2185, and outpatient services with 20% coinsurance. Emergency services have a $110 copay, and primary care, hearing, and vision services are available with no copay and coinsurance. This plan also includes dental coverage with a $4,000 annual maximum, home health services with no copay, and medical equipment with 20% coinsurance. Additional benefits include ambulance services, home infusion, and some other services like acupuncture and over-the-counter items, with varying costs and coverage limits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, the copay is $2185 per admission or stay, and for Inpatient Hospital Psychiatric, the copay is $2036 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay. Ambulatory surgical center services, individual outpatient substance abuse sessions, and group outpatient substance abuse sessions have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial hospitalization is covered under the HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan, but prior authorization is required. You will pay 20% coinsurance for this benefit.
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 any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $110 copay and no coinsurance. Urgently Needed Services have no copay and a 20% coinsurance.
Primary Care See details
The HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan covers primary care, chiropractic, occupational therapy, specialist, mental health, and psychiatric services with a 20% coinsurance, and additional telehealth services with a 20% coinsurance and no copay. Podiatry services are not covered.
Preventive Services See details
The HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan covers preventive services including an annual physical exam with no copay. Other preventive services such as Health Education, In-Home Safety Assessment, and Personal Emergency Response System (PERS) are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Routine hearing exams have no copay and a 20% coinsurance, while fitting/evaluation for hearing aids has no copay and no coinsurance. Prescription hearing aids (all types) have no copay, and are limited to 2 visits every three years. Prescription hearing aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, but require 20% coinsurance and are subject to a $75 maximum benefit per year. Eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay, and a combined maximum benefit of $250 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $4,000 annual maximum benefit for both in-network and out-of-network services. The plan covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery with no copay, but 20% coinsurance for Medicare dental services. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is no copay, and coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan. This plan requires prior authorization and has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and no copay, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, and Lab Services have a coinsurance of at most 20% with no copay. Diagnostic Radiological Services have a coinsurance of at most 20% with a copay of at most $325, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a coinsurance of at most 20% and a copay of $50.
Home Health Services See details
Home Health Services are covered by the HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
For the HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan, Cardiac Rehabilitation Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) covers acupuncture with 20% coinsurance and a limit of 20 treatments per year, and over-the-counter items with a maximum benefit of $2400 per year. The plan also covers a meal benefit with no copay, and certain other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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