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Humana Value Plus H5525-041 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5525-041 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Plus H5525-041 (PPO) in 2026, please refer to our full plan details page.
Humana Value Plus H5525-041 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Ohio. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Value Plus H5525-041 (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 Value Plus H5525-041 (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 Value Plus H5525-041 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 Value Plus H5525-041 (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics, there is no copay for 1-month or 3-month supplies filled at standard pharmacies or through preferred mail order. Tier 2 generics cost a $5 copay for a 1-month supply, but you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brands carry a $47 copay for a 1-month supply, while a 3-month supply costs $131 via preferred mail order and $141 through standard pharmacies. Tier 4 non-preferred drugs require a 38% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply across standard pharmacies and mail order services.
Additional Benefits
The Humana Value Plus H5525-041 (PPO) plan offers comprehensive medical coverage, featuring a $2,230 copay per admission for inpatient hospital stays with no coinsurance. For routine care, primary care and specialist visits require no copay but carry a 20% coinsurance, while emergency room visits have a $115 copay with no coinsurance. Outpatient hospital services generally range from no copay to a $35 copay with 20% coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,000 annual maximum with no copay for most services. Routine vision and hearing exams are covered with no copay and a 20% coinsurance, alongside a $150 annual eyewear allowance and coverage for up to two hearing aids every three years. Additionally, home health services are available with no copay and no coinsurance, while skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Humana Value Plus H5525-041 (PPO) covers inpatient acute hospital stays with a $2,230 copay per admission and inpatient psychiatric stays with a $2,080 copay per admission, both featuring no coinsurance. Prior authorization is required, and specific services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Value Plus H5525-041 (PPO) covers outpatient hospital services with a $0 to $35 copay and 20% coinsurance, and ambulatory surgical center services with no copay and 20% coinsurance. Outpatient substance abuse services require a $35 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Value Plus H5525-041 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Value Plus H5525-041 (PPO) partially covers ambulance and transportation services, providing Medicare-covered ground and air ambulance services for a $335 copay and no coinsurance, with prior authorization required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Humana Value Plus H5525-041 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Value Plus H5525-041 (PPO) covers primary care, specialist visits, and physical, occupational, and speech therapies with no copay and 20% coinsurance, while telehealth services require a $0 to $40 copay and 20% coinsurance. Mental health, psychiatric, and opioid treatment services are covered with a $35 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Value Plus H5525-041 (PPO) provides partially covered preventive services with no copay and no coinsurance for covered options such as annual physicals, kidney disease education, smoking cessation, memory fitness, and diabetes self-management. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, weight management programs, and alternative therapies.
Hearing Services See details
Humana Value Plus H5525-041 (PPO) hearing services are partially covered, featuring routine hearing exams once per year with a 20% coinsurance and no copay, alongside unlimited hearing aid fittings with no copay or coinsurance. Up to two prescription hearing aids are covered every three years with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Humana Value Plus H5525-041 (PPO) covers routine eye exams with no copay and a 20% coinsurance up to a $75 annual limit, though other eye exam services are not covered. Eyewear is partially covered with no copay and no coinsurance up to a $150 annual limit for one pair of contact lenses or eyeglasses, but separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Value Plus H5525-041 (PPO) partially covers dental services up to a $2,000 annual maximum, offering Medicare-covered dental with no copay and a 20% coinsurance, and other dental services with no copay and no coinsurance. Covered benefits include cleanings, exams, x-rays, restorative care, endodontics, periodontics, fixed prosthodontics, and oral surgery, while fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Value Plus H5525-041 (PPO) covers home infusion bundled services, which require prior authorization and step therapy. Covered Medicare Part B insulin drugs carry a $35 copay and 0% to 20% coinsurance, other Part B drugs require no copay and 0% to 20% coinsurance, and chemotherapy drugs require a copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Value Plus H5525-041 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Value Plus H5525-041 (PPO) covers durable medical equipment, prosthetics, medical supplies, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, though prior authorization is required for most equipment and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Value Plus H5525-041 (PPO) covers diagnostic and radiological services, subject to prior authorization and a minimum 20% coinsurance for most services. Lab services require no copay, outpatient X-rays have a $40 copay, and diagnostic procedures and radiological services range from no copay up to a $40 copay depending on the service.
Home Health Services See details
Humana Value Plus H5525-041 (PPO) provides coverage for home health services with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Value Plus H5525-041 (PPO) with no copay and a 20% coinsurance, though prior authorization is required. While some services are covered, specific sub-services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Value Plus H5525-041 (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Humana Value Plus H5525-041 (PPO) provides partially covered other services, featuring acupuncture with no copay and 20% coinsurance for up to 20 treatments per year, alongside a chronic illness meal benefit with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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