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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 2025, 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 2025.
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 $38.00. 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 $9350.00 (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 $9350.00 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 Full Access H5525-042 (PPO) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance for your medications, depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $20 copay for preferred generic drugs at most pharmacies, while standard generic drugs have a $47 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Full Access H5525-042 (PPO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $470, as well as ambulance services with a $315 copay. Primary care visits have a $30 copay, and specialist visits cost $55. Preventive services, such as annual physical exams and glaucoma screenings, are covered with no copay. Vision services include eye exams with copays between $0 and $55, and eyewear with no copay, and dental services include Medicare dental services with a $55 copay. This plan also covers home health services and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Humana Full Access H5525-042 (PPO) plan. For Inpatient Hospital-Acute, you'll pay a $470 copay for days 1-5 and no copay for days 6-90, with additional days 91-999 having no copay; for Inpatient Hospital Psychiatric, you'll pay a $470 copay for days 1-4 and no copay for days 5-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $470, Observation Services have a $470 copay, Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $45 and $100.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Full Access H5525-042 (PPO). This plan has a $315 copay for both ground and air ambulance services, with no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Full Access H5525-042 (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services has a $45 copay; all have no coinsurance.
Primary Care See details
The Humana Full Access H5525-042 (PPO) plan covers primary care physician services with a $30 copay, chiropractic services with a $15 copay (prior authorization required), and occupational therapy services with a copay between $10 and $35 (prior authorization required). Physician specialist services have a $55 copay, and mental health specialty services have a $45 copay for individual and group sessions (prior authorization required). Physical therapy and speech-language pathology services have a copay between $10 and $35 (prior authorization required), while additional telehealth benefits have a copay between $0 and $55. Opioid treatment program services have a copay between $45 and $100 (prior authorization required). Podiatry services are not covered.
Preventive Services See details
The Humana Full Access H5525-042 (PPO) plan covers preventive services with no copay for an annual physical exam, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. This plan also covers wigs for hair loss related to chemotherapy and fitness benefits with no copay. Additional preventive services are covered, but may have a copay.
Hearing Services See details
Hearing Services are partially covered by the Humana Full Access H5525-042 (PPO) plan. Hearing exams have a $55 copay, but Routine Hearing Exams, Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids (all types), Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear and OTC Hearing Aids are not covered.
Vision Services See details
The Humana Full Access H5525-042 (PPO) plan covers eye exams with a copay between $0 and $55 and eyewear with no copay; however, eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan also covers routine eye exams, contact lenses, and eyeglasses (lenses and frames) with no copay.
Dental Services See details
The Humana Full Access H5525-042 (PPO) plan covers Medicare Dental Services with a $55 copay, and other dental services like oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatments, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Adjunctive general services are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require 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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance between 20% and 20%. Prior authorization is required.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 20% coinsurance, and durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance. Diabetic supplies have a 10-20% coinsurance and no copay, while diabetic therapeutic shoes/inserts have a $10 copay.
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. Diagnostic Procedures/Tests have a copay of up to $55 and a coinsurance of at least 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $720 and a coinsurance of at least 20%, Therapeutic Radiological Services have a copay of $55 and a coinsurance of at least 20%, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Humana Full Access H5525-042 (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, but not the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD. Prior authorization is required, and there is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Full Access H5525-042 (PPO) plan, but require prior authorization. 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
The Humana Full Access H5525-042 (PPO) plan covers acupuncture with a $55 copay and a limit of 20 treatments per year, but other services such as Over-the-Counter (OTC) Items, Meal Benefit, and many others are not covered.
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