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HumanaChoice SNP-DE H5525-045 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5525-045 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice SNP-DE H5525-045 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Kentucky. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice SNP-DE H5525-045 (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HumanaChoice SNP-DE H5525-045 (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice SNP-DE H5525-045 (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.
For HumanaChoice SNP-DE H5525-045 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.60. 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 HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs based on the drug tier until your total drug costs reach $2000.00. If you qualify for the low-income subsidy, you will pay $49.60 for your Part D plan. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan offers a variety of benefits, including inpatient and outpatient hospital services, with varying copays and coinsurance. You'll also find coverage for ambulance, emergency, and primary care services, as well as preventive, hearing, vision, and dental services. The plan includes no copays for many services, but has coinsurance of 20% for others.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $2185.00 per admission or stay, and additional days are covered with no copay. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $2036.00 per admission or stay, while additional days are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and Ambulatory Surgical Center (ASC) services with 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, are covered with a 20% coinsurance. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $315 copay. Transportation Services to a plan-approved health-related location are covered with no copay for up to 24 one-way trips per year, but 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 by the HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services, all with 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services with varying copays. 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 (PERS), medical nutrition therapy (MNT), and other services are not covered.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a 20% coinsurance for routine hearing exams, and there is no copay. Prescription hearing aids have no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered, with a maximum benefit of $30 every three months, and there is no copay.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $4,000 maximum benefit per year. Medicare Dental Services have a 20% coinsurance, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Implant Services, Prosthodontics (fixed), and Oral and Maxillofacial Surgery have no copay. Fluoride Treatment and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%, with no copay.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan. Prior authorization is required, and you will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with a coinsurance and copay (see details below). Durable Medical Equipment for use outside the home is not covered. For Diabetic Supplies, there is a 20% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a coinsurance of at most 20% and lab services with no copay and a coinsurance of at most 20%. Diagnostic radiological services have a copay of at most $325 and a coinsurance of at most 20%, therapeutic radiological services have a coinsurance of at most 20%, and outpatient X-ray services have a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; there is no coinsurance. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The "Other Services" benefit includes acupuncture with 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are also covered, with a maximum benefit of $30 every three months. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and other services are not covered.
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