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HumanaChoice SNP-DE H5525-046 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice SNP-DE H5525-046 (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 H5525-046 (PPO D-SNP) in 2025, please refer to our full plan details page.
HumanaChoice SNP-DE H5525-046 (PPO D-SNP) is a PPO D-SNP 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 HumanaChoice SNP-DE H5525-046 (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 H5525-046 (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 H5525-046 (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 H5525-046 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.30. 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 H5525-046 (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you'll pay $39.30 for Part D. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice SNP-DE H5525-046 (PPO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a high copay per admission, while outpatient services, including blood services, have no copay. Other services like primary care, hearing exams, and vision services are available with no copay or a small coinsurance. This plan also includes coverage for ambulance services, with a copay, and transportation to health-related locations, with no copay for up to 24 one-way trips per year. Dental services, home health, and skilled nursing facility services are covered, with some services having no copay. The plan also includes over-the-counter items with a maximum benefit, and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, with a copay of $2185 per admission for acute care and $2036 per admission for psychiatric care. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with 20% coinsurance and a $45 copay for individual and group sessions. Outpatient Blood Services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a copay of $305. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year. 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 HumanaChoice SNP-DE H5525-046 (PPO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a 20% coinsurance; the Worldwide Emergency Services have a $110 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits cover services such as 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. This plan has a 20% coinsurance for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits, and a copay of $45 for Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services. Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services have a $45 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services are covered, but copays apply. Other services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
The HumanaChoice SNP-DE H5525-046 (PPO D-SNP) plan covers hearing exams with up to 20% coinsurance, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per ear, and OTC hearing aids are covered with a $0 copay and a maximum benefit of $500 per ear. Prescription hearing aids - Inner Ear, Prescription hearing aids - Outer Ear, and Prescription hearing aids - Over the Ear are not covered.
Vision Services See details
The HumanaChoice SNP-DE H5525-046 (PPO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear. Eyewear includes contact lenses with no copay and 20% coinsurance, and eyeglasses (lenses and frames) with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, and Adjunctive General Services with no copay. This plan does not cover Fluoride Treatment, Endodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, or Orthodontics. Other Dental Services have a maximum benefit of $1,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while other Medicare Part B drugs have no copay with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice SNP-DE H5525-046 (PPO D-SNP) plan and require prior authorization. The coinsurance for this benefit is 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), prosthetics, medical supplies, and diabetic equipment, is covered by this plan. DME has a 20% coinsurance, and medical supplies and prosthetic devices have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the HumanaChoice SNP-DE H5525-046 (PPO D-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, and Lab Services have a 20% coinsurance with no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $325, while Therapeutic Radiological Services and Outpatient X-Ray Services both have a coinsurance of at most 20%, with Outpatient X-Ray Services also having a $50 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice SNP-DE H5525-046 (PPO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice SNP-DE H5525-046 (PPO D-SNP) plan covers acupuncture with a 20% coinsurance, up to 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $1200 per year. This plan provides a meal benefit with no copay. However, the plan does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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