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Humana Dual Select H5525-046 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select 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 Humana Dual Select H5525-046 (PPO D-SNP) in 2026, please refer to our full plan details page.
Humana Dual Select 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 2026.
It's important to know that Humana Dual Select 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:
Humana Dual Select 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 Humana Dual Select 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 Humana Dual Select H5525-046 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.40. 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:
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Drug Coverage
The Humana Dual Select H5525-046 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for both 1-month and 3-month supplies at standard pharmacies and through preferred mail order. However, standard mail order for these generic tiers requires a copay ranging from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For higher-tier medications, including Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan charges a consistent 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order options. Specialty tier drugs are limited to a 1-month supply, while Tier 3 and Tier 4 drugs maintain the 25% coinsurance for both 1-month and 3-month supplies.
Additional Benefits
The Humana Dual Select H5525-046 (PPO D-SNP) offers comprehensive medical coverage, featuring preventive services, home health visits, and select dental and hearing benefits with no copay and no coinsurance. For routine medical care, primary and specialist visits require no copay but carry a 20% coinsurance, while inpatient hospital stays require a copay of $2,230 for acute care with no coinsurance. Emergency room visits have a $115 copay, and urgent care services require a 20% coinsurance with no copay. Specialized services like durable medical equipment, dialysis, and diagnostic tests generally require a 20% coinsurance and no copay. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Additionally, the plan provides valuable extra benefits including up to 24 one-way transportation trips per year, over-the-counter items, and chronic illness meals all with no copay and no coinsurance.
Inpatient Hospital See details
Humana Dual Select H5525-046 (PPO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,230 copayment per stay for acute care and a $2,080 copayment per stay for psychiatric care. Prior authorization is required for both services, and while unlimited additional acute care days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Dual Select H5525-046 (PPO D-SNP) covers outpatient hospital and observation services with a $0 to $35 copay and 20% coinsurance, and ambulatory surgical center services with no copay and 20% coinsurance. Outpatient substance abuse sessions require a $35 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Humana Dual Select H5525-046 (PPO D-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Dual Select H5525-046 (PPO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Humana Dual Select H5525-046 (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 are covered with a 20% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Dual Select H5525-046 (PPO D-SNP) offers primary care, specialist, physical therapy, and occupational therapy services with no copay and 20% coinsurance, while podiatry is not covered. For chiropractic services, some services are covered but routine and other chiropractic care are not covered. Mental health, psychiatric, and opioid treatment services have a $35 copay with no coinsurance, and telehealth benefits range from a $0 to $35 copay with 20% coinsurance.
Preventive Services See details
Humana Dual Select H5525-046 (PPO D-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and various screenings. Additional preventive services are partially covered, but fitness benefits, health education, PERS, counseling, weight management, therapeutic massage, alternative therapies, adult day health, and in-home, nutritional, palliative, or caregiver support services are not covered.
Hearing Services See details
Humana Dual Select H5525-046 (PPO D-SNP) covers hearing services with no copay and no coinsurance for fitting evaluations, OTC hearing aids, and prescription hearing aids, while routine hearing exams require a 20% coinsurance and no copay. Prescription hearing aids are partially covered, as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Dual Select H5525-046 (PPO D-SNP) partially covers vision services with no deductibles, offering routine eye exams, contact lenses, and eyeglasses with no copays, though a 20% coinsurance applies to routine exams and contact lenses. Other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Humana Dual Select H5525-046 (PPO D-SNP) offers partially covered dental services, with fixed prosthodontics not covered under the plan. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $500 annual maximum.
Home Infusion bundled Services See details
Humana Dual Select H5525-046 (PPO D-SNP) covers home infusion bundled services, which require prior authorization and step therapy. Covered Part B insulin requires a $35 copay and ranges from no coinsurance to 20% coinsurance, while other Part B drugs feature no copay and range from no coinsurance to 20% coinsurance. Chemotherapy and radiation drugs are also covered and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services covered under the Humana Dual Select H5525-046 (PPO D-SNP) plan require a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
Humana Dual Select H5525-046 (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Dual Select H5525-046 (PPO D-SNP) covers diagnostic and radiological services with a 20% coinsurance and prior authorization requirements. There is no copay for diagnostic procedures, lab services, and diagnostic radiological services, while outpatient x-ray services require a $50 copay.
Home Health Services See details
Home Health Services are covered under the Humana Dual Select H5525-046 (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Dual Select H5525-046 (PPO D-SNP) offers some covered cardiac rehabilitation services with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Dual Select H5525-046 (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered, though a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
Humana Dual Select H5525-046 (PPO D-SNP) covers acupuncture with no copay and 20% coinsurance for up to 20 treatments per year. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, while other specific supplemental services are not covered.
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