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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 2026, 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 2026.
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 $38.40. 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 $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:
Sign up for HumanaChoice SNP-DE H5525-045 (PPO D-SNP)
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Drug Coverage
The HumanaChoice SNP-DE H5525-045 (PPO D-SNP) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled through standard retail pharmacies or preferred mail order. If you use standard mail order for these generic tiers, you will face a copay of $10 to $20 for a one-month supply. For Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan requires a 25% coinsurance. This 25% coinsurance applies to one-month and three-month supplies across standard pharmacies, preferred mail order, and standard mail order. Knowing these prescription costs helps you budget effectively for your medication needs with this Humana Medicare plan.
Additional Benefits
The HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan offers comprehensive medical coverage, featuring no copays and a 20% coinsurance for primary care, specialist visits, outpatient services, and dialysis. Inpatient hospital stays require a copay of $2,230 for acute care or $2,080 for psychiatric care, but carry no coinsurance. Emergency care is available with a $115 copay, while preventative services and home health care are fully covered with no copays or coinsurance. For specialized care, the plan provides dental benefits up to a $2,000 annual limit and vision eyewear coverage up to $550 with no copays or coinsurance. Routine hearing exams and medical equipment generally require a 20% coinsurance and no copay, with up to two prescription hearing aids covered every three years at no cost. Additionally, skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) inpatient hospital care is partially covered with no coinsurance, requiring prior authorization along with a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Sub-services that are not covered include upgrades and non-Medicare-covered stays for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care.
Outpatient Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay. Members are responsible for a 20% coinsurance for these services, and prior authorization is required.
Partial Hospitalization See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance, with prior authorization required. Some transportation services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) 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 require a 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent care, and emergency transportation are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and 20% coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) preventive services are partially covered with no copay and no coinsurance for covered services like annual physical exams, memory fitness, kidney disease education, and select screenings. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home modifications, and counseling.
Hearing Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) partially covers hearing services with no deductible, offering one annual routine hearing exam with a 20% coinsurance and no copay, and unlimited fitting evaluations with no copay or coinsurance. Up to two prescription hearing aids are covered every three years with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) partially covers vision services, offering one routine eye exam per year with no copay and 20% coinsurance up to a $40 limit, while other eye exam services are not covered. Eyewear is also partially covered with no copay and no coinsurance up to a $550 annual limit for one pair of contact lenses or eyeglasses (lenses and frames), though individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice SNP-DE H5525-045 (PPO D-SNP) up to a $2,000 annual limit, featuring no copay and a 20% coinsurance for Medicare-covered dental care, and no copay and no coinsurance for other covered preventive and comprehensive services. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) covers home infusion bundled services with prior authorization, featuring Medicare Part B insulin at a $35 copay and 0% to 20% coinsurance. Other Medicare Part B drugs require no copay and a 0% to 20% coinsurance, while chemotherapy and radiation drugs are covered with a copay and 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical equipment is covered under the HumanaChoice SNP-DE H5525-045 (PPO D-SNP) plan with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic services. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) covers diagnostic and radiological services subject to prior authorization, with diagnostic procedures, tests, and lab services requiring no copay and a 20% coinsurance. Outpatient X-rays require a $50 copay, diagnostic radiological services require a $200 copay, and therapeutic radiological services require a copay, with all radiological services also carrying a 20% coinsurance.
Home Health Services See details
Home health services are covered by HumanaChoice SNP-DE H5525-045 (PPO D-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
HumanaChoice SNP-DE H5525-045 (PPO D-SNP) provides cardiac rehabilitation services with no copay and required prior authorization, though some services are covered while specific sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and subject to a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice SNP-DE H5525-045 (PPO D-SNP) with no coinsurance and does not require a prior three-day inpatient hospital stay. Under this plan, there is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with prior authorization required and additional days not covered.
Other Services See details
Other Services under HumanaChoice SNP-DE H5525-045 (PPO D-SNP) are partially covered, offering a meal benefit with no copay and no coinsurance, and up to 20 acupuncture treatments per year with no copay and 20% coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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