HumanaChoice SNP-DE H5525-036 (PPO D-SNP)

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 North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.

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.

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.

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:

Drug Coverage

The HumanaChoice SNP-DE H5525-036 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a standard pharmacy or preferred mail order for either 1-month or 3-month supplies. However, standard mail order delivery for these generic tiers requires a copay ranging from $10 to $30 for Tier 1 and $20 to $60 for Tier 2. For higher-tier medications, the plan transitions from flat copays to coinsurance. Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance. This 25% coinsurance rate remains the same whether you fill your prescriptions at a standard pharmacy, through preferred mail order, or via standard mail order.

Additional Benefits

The HumanaChoice SNP-DE H5525-036 (PPO D-SNP) plan offers comprehensive healthcare coverage with no copays and a 20% coinsurance for most primary care, specialist, outpatient, and medical equipment services. Inpatient hospital stays require a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay, while skilled nursing facility visits feature no copay for the first 20 days. Emergency services carry a $115 copay, which is waived if admitted within 24 hours, and ground or air ambulance services require a $335 copay. Members also benefit from routine preventive and home health services with no copays or coinsurance. Dental care is covered with no copay and no coinsurance up to a $4,000 annual limit, and select eyewear and over-the-counter hearing aids are provided with no copays or coinsurance. Routine eye and hearing exams are covered with no copay and a 20% coinsurance, alongside chronic illness meal benefits and over-the-counter items at no cost.