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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 2025, 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 2025.
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 $11.00. 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 Humana Value Plus H5525-041 (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $15 copay for preferred generic drugs at a standard or preferred mail pharmacy, while standard generic drugs have a $47 copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase, and you pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Value Plus H5525-041 (PPO) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with 20% coinsurance, and emergency services with a copay. Preventive services such as an annual physical exam, smoking cessation counseling, and fitness benefits are available with no copay. The plan also provides coverage for vision services with no copay for eye exams, and partial dental coverage with 20% coinsurance for Medicare-covered services. Additional benefits include home health services with no copay, skilled nursing facility care with copays for specific days, and medical equipment coverage with coinsurance. The plan also covers ambulance services with a copay, and diagnostic and radiological services with a mix of copays and coinsurance. However, it's important to note that some services, such as hearing aids and certain dental and vision services, are not covered, and prior authorization is required for some services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization required. The copay for a Medicare-covered stay is $2185 for Inpatient Hospital-Acute and $2036 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
The Humana Value Plus H5525-041 (PPO) plan covers outpatient hospital services with a 20% coinsurance and no copay, observation services with a 20% coinsurance, and ambulatory surgical center services with a 20% coinsurance and no copay. Outpatient substance abuse services, including individual and group sessions, are covered with a 20% coinsurance, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Value Plus H5525-041 (PPO) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Value Plus H5525-041 (PPO) plan. Ground and Air Ambulance Services have a copay of $315, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Value Plus H5525-041 (PPO) plan. Emergency Services have a $110 copay with no coinsurance, Urgently Needed Services have a $45 copay with no coinsurance, and Worldwide Emergency Services have a $110 copay with no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Value Plus H5525-041 (PPO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, all with 20% coinsurance. The plan does not cover Podiatry Services, and routine chiropractic care is not covered. Additional Telehealth Benefits have a copay between $0 and $45.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and the additional services of smoking cessation counseling and fitness benefits, both with no copay. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing Services are covered, but Routine Hearing Exams, Fitting/Evaluation for Hearing Aids, Prescription Hearing Aids (all types, inner ear, outer ear, and over the ear), and OTC Hearing Aids are not covered. Hearing Exams have a coinsurance of at most 20%.
Vision Services See details
The Humana Value Plus H5525-041 (PPO) plan covers vision services, including eye exams with no copay and 20% coinsurance. Eyewear benefits include contact lenses and eyeglasses (lenses and frames) with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered under the Humana Value Plus H5525-041 (PPO) plan. Medicare Dental Services have a 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with an 18% coinsurance and no copay, Prosthetics/Medical Supplies with no copay and 20% coinsurance for some services, and Diabetic Equipment with a 20% coinsurance and no copay for some services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered by the Humana Value Plus H5525-041 (PPO) plan. Diagnostic procedures/tests have a coinsurance of at most 20% and a maximum copay of $45, while lab services have no copay and a coinsurance of at most 20%. Diagnostic radiological services have a coinsurance of at most 20% and a copay of at most $325, outpatient X-ray services have a $50 copay and a coinsurance of at most 20%, and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Value Plus H5525-041 (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
Cardiac Rehabilitation Services are covered by the Humana Value Plus H5525-041 (PPO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Value Plus H5525-041 (PPO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Value Plus H5525-041 (PPO) plan covers acupuncture with 20% coinsurance and a limit of 20 treatments per year, and meal benefits with no copay. Other services like over-the-counter items, dual eligible SNPs, and several additional services are not covered.
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