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HumanaChoice H5525-049 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-049 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-049 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-049 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-049 (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 HumanaChoice H5525-049 (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 HumanaChoice H5525-049 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $350.00 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 HumanaChoice H5525-049 (PPO) Medicare plan features an annual prescription drug deductible of $350. You will pay no copay for Tier 1 preferred generic drugs when utilizing a standard pharmacy or preferred mail order for either 1-month or 3-month supplies. Tier 2 generic medications require a low $5 copay for a 1-month supply at standard pharmacies, with no copay for a 3-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, the plan features a $47 copay for a 1-month supply across standard pharmacies and mail order options. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 47% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance. These structured costs help you easily estimate your out-of-pocket prescription expenses under this PPO plan.
Additional Benefits
The HumanaChoice H5525-049 (PPO) plan offers strong core medical coverage with no copay for primary care doctor visits, home health services, and annual physical exams. Specialist visits and outpatient mental health services require a $35 copay with no coinsurance. For emergencies and hospitalizations, members pay a $115 copay for emergency room visits and a $375 daily copay for the first seven days of an inpatient hospital stay. Essential routine vision, dental, and hearing exams are available with no copay, though there are limits on eyewear allowance and a $699 to $999 copay for prescription hearing aids. Skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Durable medical equipment and dialysis services require no copay and a 20% coinsurance.
Inpatient Hospital See details
HumanaChoice H5525-049 (PPO) covers inpatient hospital stays with no coinsurance, requiring a $375 daily copay for days 1 to 7 for acute care (with no copay for days 8 and beyond) and a $375 daily copay for days 1 to 5 for psychiatric care. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
HumanaChoice H5525-049 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
HumanaChoice H5525-049 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
HumanaChoice H5525-049 (PPO) provides partial coverage for ambulance and transportation services, offering ground and air ambulance services with a $335 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
HumanaChoice H5525-049 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-049 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and psychiatric services require a $35 copay and no coinsurance. Physical and occupational therapy are covered with a $25 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5525-049 (PPO) partially covers preventive services, providing annual physical exams, kidney disease education, and diabetes self-management training with no copay and no coinsurance. Additional benefits such as fitness programs, health education, personal emergency response systems, weight management, and nutritional services are not covered.
Hearing Services See details
HumanaChoice H5525-049 (PPO) covers Medicare-covered hearing exams for a $35 copay and no coinsurance, while routine exams and hearing aid fittings are covered with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two aids per year, though over-the-counter (OTC), inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HumanaChoice H5525-049 (PPO) vision services are partially covered with no coinsurance, offering no copay for one routine annual eye exam and no copay for contact lenses or eyeglasses. Annual maximum benefits are limited to $75 for exams and $150 for eyewear, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-049 (PPO) offers partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental services, and no copay or coinsurance for other covered preventive and comprehensive services. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5525-049 (PPO) with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance ranging from no coinsurance up to 20%, while covered insulin carries a $35 copay and up to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5525-049 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice H5525-049 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, subject to prior authorization. Diabetic supplies are covered with no copay and a 10% to 20% coinsurance from specified manufacturers, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5525-049 (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic services, which feature a copay ranging from $0 to $120, and no copay for lab work. Outpatient X-rays and diagnostic radiological services have no copay, while therapeutic radiological services require a minimum $35 copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5525-049 (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5525-049 (PPO) with no coinsurance, although prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-049 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5525-049 (PPO) partially covers other services, offering acupuncture for a $35 copay and no coinsurance for up to 20 treatments per year, subject to prior authorization. Supplemental benefits such as over-the-counter (OTC) items and meal benefits are not covered.
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