A non-government entity
Humana Full Access H5525-042 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H5525-042 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H5525-042 (PPO) in 2026, please refer to our full plan details page.
Humana Full Access H5525-042 (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 Full Access H5525-042 (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 Full Access H5525-042 (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 Full Access H5525-042 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. 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 $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 $9150.00 (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 $9150.00 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:
Sign up for Humana Full Access H5525-042 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Full Access H5525-042 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost as low as a $5 copay for a 1-month supply, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail-order options. Tier 4 non-preferred drugs carry a 35% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. Understanding these tier costs and pharmacy options can help you maximize your savings with this Humana PPO plan.
Additional Benefits
The Humana Full Access H5525-042 (PPO) plan offers robust coverage with no copay for primary care visits, while specialist visits require a $55 copay. For hospital stays, inpatient care features a $470 daily copay for the first five days and no copay thereafter, while outpatient hospital services range from no copay up to a $550 copay. Emergency room visits carry a $115 copay, which is waived if you are admitted, and urgent care is available for a $40 copay. Routine dental, vision, and hearing exams are covered with no copay, though prescription hearing aids require copays between $699 and $999. Skilled nursing facility care has no copay for the first 20 days, and home health services are fully covered with no copay or coinsurance. Most durable medical equipment and dialysis services require a 20% coinsurance, while preventive services and annual physicals feature no copay.
Inpatient Hospital See details
Humana Full Access H5525-042 (PPO) covers inpatient acute hospital stays with no coinsurance and a $470 daily copay for days 1 through 5, and no copay for days 6 and beyond. Inpatient psychiatric stays are covered with no coinsurance and a $470 daily copay for days 1 through 4, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Full Access H5525-042 (PPO) outpatient services are covered with no coinsurance, featuring a $0 to $550 copay for outpatient hospital services and a $470 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse individual and group sessions carry a $35 copay with no coinsurance.
Partial Hospitalization See details
Humana Full Access H5525-042 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Humana Full Access H5525-042 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Humana Full Access H5525-042 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are available for 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 Full Access H5525-042 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Additional benefits like therapy, mental health, and telehealth services feature no coinsurance and copays ranging from $0 to $55, while podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Full Access H5525-042 (PPO) preventive services are partially covered, offering no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, glaucoma screenings, diabetes training, and memory fitness. Chemotherapy wigs are also covered with no copay up to a $500 annual limit. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Full Access H5525-042 (PPO) covers hearing services with no deductible and no coinsurance, offering routine hearing exams and fitting evaluations for no copay, and Medicare-covered exams for a $55 copay. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 for up to two aids per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Humana Full Access H5525-042 (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible, though prior authorization is required. Covered benefits include one routine eye exam per year (up to a $75 limit) and one pair of contact lenses or eyeglasses (lenses and frames) per year with a combined $100 maximum limit. Other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Full Access H5525-042 (PPO) provides partially covered dental services with a $55 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for preventive and most comprehensive services. Covered benefits include oral exams, cleanings, x-rays, and restorative services, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Full Access H5525-042 (PPO) with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry a coinsurance ranging from 0% to 20%, while Part B insulin drugs have a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Full Access H5525-042 (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Full Access H5525-042 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Full Access H5525-042 (PPO) with prior authorization, featuring no copay for lab services, outpatient x-rays, and diagnostic radiology. Diagnostic procedures and therapeutic radiology require a minimum 20% coinsurance, with copayments ranging from no copay up to $55 depending on the service.
Home Health Services See details
Home Health Services are covered under the Humana Full Access H5525-042 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Full Access H5525-042 (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Full Access H5525-042 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day inpatient hospital stay requirement. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100 under prior authorization, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Full Access H5525-042 (PPO) partially covers other services, providing acupuncture with a $55 copay and no coinsurance for up to 20 treatments per year, requiring prior authorization. Over-the-counter items, meal benefits, and other additional services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved